Selecting the correct course
What kind of treatment is most appropriate for the individual's problem?
Following an assessment
of the problem, there are many different treatment
options. It is often difficult for parents
to assess whether or
not professionals need to be involved with their
child. Many factors will weigh into the decision
making process. If parents themselves have experienced
treatment or some kind
of mental health intervention either as a child or as an
adult their experience (positive or negative) will affect
the decisions about their children.
The question that parents need to consider is, "if
your child cuts himself, and the cut begins to bleed,
how much blood do you need to see before you decide
he needs to be taken to the hospital"? In other words,
will some kind of intervention be necessary to begin to
heal the wound.
The Options: How to Choose?
Diversity is a positive thing
- Parents are frequently concerned that their
child may pick up a worse drug habit if exposed to other
people involved in these programs. This question is often
a sign of denial. They should ask themselves: "Am
I denying my teen's drug problem?" Diversity will
help the teen see the rest of the world and how treatment
helps others to concentrate on the positive elements.
The following checklist will help in determining the
proper treatment option for teens:
- Is the patient population all adolescents?
- Is the patient population mixed
- Is there planning available for
continuing care after treatment ends?
- Are there 12 - step meetings available
or on site?
- Are other community resources discussed
- Is the staff licensed?
- Is family therapy or support used
as part of treatment?
- Are other life management skills
taught? I.e., nutrition, exercise, hygiene.
- Is meditation, relaxation, stress
reduction part of treatment?
- Is abstinence the goal of treatment?
Intervention Program - Intervention
programs for teens come in all shapes and sizes. They
can be part of human service agencies, schools, medical
treatment centers, doctor's offices,
psychologists' offices, town or city services. They may vary in intensity
from educational sessions to complicated integration
with other agencies and therapeutic
group and family sessions. Intervention programs generally have the goal
of helping individuals recognize that substance abuse
is getting in the way of
their living a comfortable manageable life. Helping that individual move
forward out of their current problem behaviors, by helping
them accept the fact that
problems exist, helping them recognize that substance abuse has something
to do with those problems, and helping them learn to
plan a better way to live.
Coercion generally plays a large role in these programs. Teens feel forced
by family, police, school, court to participate. Generally they do not accept
that their behaviors play a role in the issue at hand.
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Out-patient Treatment -
treatment is an intervention that is performed outside
of a residential treatment or hospital setting,
although some outpatient services are located on hospital
grounds. The service is traditionally offered by an individual
licensed by the state to perform mental health and/or substance
abuse treatment. It can be performed in a one on one setting
(individual modality), in a group treatment modality or
by bringing in the family for family therapy. The model
of out-patient treatment can be done intensively by bringing
the patient and their family in several times per week
engaging an integrated model of modalities and clinicians;
and in a less intensive treatment with less frequent visits
and clinical interventions. For teens, it's advisable to
engage out-patient clinicians who specialize in working
with teens for the best success. Most adolescent therapists
prefer a group modality to individual treatment.
Checklist for choosing an out-patient therapist for
adolescent substance abuse.
- Therapist licensed in mental health/substance
- Therapist with 5+ years experience
- Group modality preferred (teen group)
- Therapist wants to keep parents/family
- Teen seems comfortable with therapist
- Confidentiality is maintained -
unless safety is at risk then family is brought in with
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Treatment or Partial Hospital Treatment -
Day Treatment, sometimes referred to as partial
hospital programs is a
more intensive form of commitment to treatment than out-patient treatment.
The patient commits to spending up to 6 hours per day at the facility,
attending various forms of therapeutic interventions. Partial hospital
programs can sometimes last up to 14 days. The purpose is for the patient
to attend an intensive form of treatment without having to sleep in a residential
or hospital facility. For teens, it is often difficult to find partial
hospital programs exclusively for that age group.
Often these programs mix populations so that teens
may be in a program with individuals older and
more experienced with substance abuse. There is
some controversy among professionals as to the
value of this type of mixed population in treatment.
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Treatment (Detox) -
The purpose of hospital care for any individual abusing
substances is to help
stay medically safe. These programs often referred
to as detoxification
units are for patients whose use of drugs puts them in physical danger
if they stop without medical supervision. These programs are typically
of 3 - 5 day duration. For teens, because of their relative short history
of substance abuse, they often do not need this type of intensive medical
supervision. Detoxification units are never a substitute for rehabilitation.
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Treatment Centers -
Beyond hospital treatment
there are programs that
exist that provide for
short and long-term rehabilitation.
These programs can last
from 1 -
9 months. For teens they are known as residential treatment centers.
Note: Managed care has greatly
restricted healthcare insurance companies from paying
for this type of treatment. Therefore
there are few programs
that currently exist,
fewer programs for teens,
and most that require
out of pocket payment.
The programs that do
exist combine various
with recreation, proper
nutrition, 12-step program
participation, as well
as teaching responsibility,
honesty and open communication.
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Halfway house treatment for individuals with substance abuse and addiction
problems is often meant as an alternative to returning home after a residential
or hospital stay. These are generally structured programs that combine
therapeutic intervention, 12 step programs and community living with
other individuals in recovery. It is usually recommended for those individuals
whose home environment is not able to support an individual's abstinence
from alcohol and other drugs. There are very few opportunities for teens
to participate in these programs. The houses are generally designed for
individuals beyond the age of adolescence.
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Alcoholics Anonymous and
other 12 - Step Programs - For teens,
sustained abstinence from alcohol and other mind-altering
substances is the goal of the various treatment
programs previously mentioned. For
this reason, 12 - step programs like AA are often used as part of the
treatment's program. These self-help programs
promote abstinence as a way of improving
the manageability of an individuals life. Positive aspects of these programs:
- No fees required
- Meetings available 7 days per
week, all different times of day, all over the
- Promotes people helping people.
- The most successful
form of intervention historically known for substance
Negative aspects of these programs:
- Teen groups not
as available as adult groups.
- Success requires self-motivation
- difficult for emotionally troubled teens.
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Therapy for Adolescents -
This type of treatment focuses on changing negative behavior by demonstrating
more accepted behavior in incremental steps. Specific strategies include
fulfilling assignments, rehearsing wanted behaviors and recording/reviewing
progress. Rewards are given after achieving desired goals. Urine testing
is a regular part of this program.
Program goals for patients include
- stimulus control: helping teens
avoid drug using situations with alternative activities
control: helping teens recognize thoughts,
feelings and plans leading to drug use;
- social control: the
inclusion of family members or significant others
to reinforce desired behavior.
According to research by the National Institute on
Drug Abuse (NIDA), including family members as well
as urinalysis increases success for teens in this program.
It also helps teens with school/work attendance, family
relationships, depression, institutionalization and
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Family Therapy for Adolescents (MDFT) -
This type of treatment focuses on the network of influences on teens eg.
individual, peer, family and community in an outpatient setting. The
goal is to focus on how these influences affect teens in different settings.
Treatment sessions are held in the clinic, at home, in family court,
school or other community locations. Individual sessions help teens with
decision making, negotiation, problem solving, communicating their thoughts
and feelings appropriately as well as vocational skills.
In order to have positive influences on their teens,
parents attend parallel sessions to help them with
their parenting style.
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(MST) - This
type of treatment focuses on more severe antisocial behavior in adolescents.
If teens and their families demonstrate any of the following, then
this type of therapy can be beneficial.
- teens and their families demonstrate favorable
attitudes toward drug use
- parents demonstrate poor discipline
- parental drug use
- peers are drug users
- teens have poor attendance or drop out
- community fosters criminal activity
takes place in teens' homes, schools and neighborhood settings. Research
has indicated that this type of treatment reduces teen drug use, incarcerations,
and out-of-home placements for at least 6 months post treatment.