Or, Rather, Treatment The treatment of SUDs (Substance Use Disorders) with adolescents varies somewhat from treatment with adults. There are a number of reasons for this, such as the usual comparatively brief exposure to the substance means less physical health complications, but the most salient difference is Developmental.
De Paul Treatment Philosophy • We recognize that addiction is a complex, chronic and treatable illness resulting from an interaction of human biology, environment and behavior • We believe that all individuals have the innate health and capacity to recover • We believe that recovery happens in the context of relationships and community • We respect the dignity and recognize the uniqueness of each individual and the need for individualized treatment.
On Treating Youth • Adolescents tend to have different reasons for using substances of abuse than adults, clustering in three general categories: • Belonging, • Self-Medicating, • Sensation Seeking
Belonging • Although there are arguably social dimensions to adult substance use, adolescence is an unparalleled period of social interaction and experimentation. Use is highly correlated with this process, and many teens who may not develop full blown SUDs are exposed to considerable use, and many use just to be part of the group.
Self Medicating • This form of use is similar to what is seen in adult populations, in that it is more often solitary. What differs is the degree to which younger people are often overwhelmed by internal psychic states and emotions and the relative lack of other effective coping strategies when compared to adults. Think middle school.
Sensation Seeking • This area is where adolescent use differs most from adult use. Endemic to the developmental phase of adolescence is a tendency toward ‘novelty seeking’. Tied to the dopaminergic or reward system, substance use can be strongly reinforced in the brain. Sensation seekers are harder to treat and have higher relapse rates than social or self medicating users.
On to the How • The young person finds healing not in isolation but in community with others • Learn how to express needs and wants.(nonviolent communication) • Opportunity to create drug free living environment • Psychiatric care for dual diagnosis clients
What Services Do We Deliver? 1) Initial and ongoing assessment services 2) Therapeutic environment (residential and outpatient) for young males and females with SUD who meet criteria for ASAM .5-III.5 and ages 13-19, boys and girls 3) We can address low acuity dual diagnosis (ASAM .5-III.5 and ages 13-19, boys and girls) 4) We offer Residential stabilization (30 days short stay) 5) And Residential long stay (2-3 months) 6) We offer family services for families suffering with substance use disorders 7) We partner with schools and provide assessment and brief treatment on site
What Models of Care Do We Use? • Recovery is a path, not an event • Adolescent treatment needs to take into account developmental stages of youth, and include family, school, referents and other stakeholders. • Main evidence based practices adopted by De Paul Youth and Family Center: Motivational Interviewing, Cognitive Behavioral Therapy (CBT), Dialetical Behavior Therapy (DBT), Seven Challenges, Seeking Safety, Cannabis Youth Treatment, Matrix Model (CBT and Relapse Prevention). • De Paul Family Therapy team uses a variety of models, mainly structural family therapy and systems theory.
Integrative Practice • Within the larger container of the therapeutic community, there are several elements that come together in the treatment of the individual client. These include: • Milieu Therapy • Individual Therapy • Group Therapy • Family Therapy • The Treatment Team works together to respond to the client’s needs, whether directly stated or communicated through client behavior.
Milieu • Milieu Counselors role: • Help keep a set schedule • Make behavioral expectations explicit and consistent • Feedback in the moment • Deliver interventions for infractions of rules • Rewards and positive feedback from staff and peers • Crisis counseling • Mediation • Community building and support • Individual skill building • Support in trying out new skills • Acting out is seen as communication of needs that requires interventions that are consistent, respectful, caring and honest.
Group • Emphasis is upon the use of group process to: • Set norms • Educate clients on addiction • Teach and role play new skills • Identify and work with reciprocal patterns of interaction • Strengthen community supports • Process individual and community issues • Process historic and familial issues as they relate to the here-and-now as well as to substance use • Role of the facilitator is to keep group safe, teach, provide opportunities for role play and real time use of learned skills, model community values, and hold clients accountable.
Why Group? • Instillation of Hope • Universality • Imparting Information • Altruism • The Corrective Recapitulation of the Primary Family Group • Development of Socializing Techniques • Imitative Behavior Source: Yalom
Individual Therapy • Emphasis throughout treatment is upon assessment and discharge planning. This includes: • Identifying what led up to the referral to treatment and making a relapse prevention plan • Identifying readiness to change and enhancing intrinsic motivation • Identifying other factors, emotional, historic, familial, that influence pattern of substance use • Help development of alternative coping strategies • Make behavioral expectations explicit and consistent • Feedback in the moment • Deliver interventions for infractions of rules • Role of the RC is to manage the case, respond to client communications and behaviors, coordinate care.
Family Therapy • Emphasis is upon identifying and intervening upon family interactive patterns that reinforce substance use and other maladaptive behaviors • Family Therapy aims at strengthening the recovery environment • Behaviors in milieu are seen as indicative of family roles and as communication of needs • Client's family is encouraged to take a central role in the treatment of the youth The Role of the Family Counselor is to be the secondary case manager, respond to client and family communications and assist in coordinating care.
ASAM 6 Dimensions 1. Acute Intoxication and/or Withdrawal Potential 2. Biomedical Conditions and Complications 3. Emotional, Behavioral or Cognitive Conditions and Complications 4. Readiness to Change 5. Relapse/Continued Use, Continued Problem Potential 6. Recovery Environment
Conclusion Adolescent care differs from adult care, because the reasons for use are different, and the developmental stage is unique. Adolescents are not individuals in the same sense as adults. This is both a risk and a potential protective factor, allowing us to intervene on the level of the many systems in which they are embedded, most importantly, family.