This article is a continuation of “Substance abuse treatment for adolescents: Part I: Elements of successful treatment.”
Peer group identification and belonging is of the utmost importance during adolescence and is an extremely influential force in teens’ lives. Peer group is also one of the hardest things to change when a teen gets clean and sober. Support groups can serve as new, sober social circles and help to foster the development of healthy relationships.
The National Institute of Drug Abuse (NIDA) 2014 Principles of Adolescent Substance Use Disorder Treatment: A Research-Based Guide includes a discussion on support groups for adolescents. Before this publication, some controversy existed in the medical community as to whether teen support groups were helpful or harmful in maintaining abstinence from drugs and alcohol.
Although 12-step groups can reinforce abstinence and other changes made during treatment, as well as provide a sense of community and lifelong support, they are not recommended as a substitute for drug treatment for adolescents. In addition, group leaders are cautioned to direct discussions among group members away from extolling drug use, a common tendency in teen group dynamics.
The 12-step solution
A well-known cure for addictive behavior occurs upon completing the process described in 12-step programs, then carrying the message to others who are suffering. The program states that this process causes a change in consciousness to occur and the desire to drink or use drugs to be lifted. The program is further defined as a spiritual cure for a spiritual ailment.
The 12-step process is a proven method for long-term abstinence. Too often, teens leave treatment without taking a personal inventory or making amends. Therefore, they still feel worthless and empty inside. They cannot wait to return to their friends to feel whole again. Their friends are still drinking and/or using, one thing leads to another and they relapse.
Twelve-step programs afford an opportunity for newly sober teens to be mentored by a peer who has already been through a similar experience. (However, it is also important to attend groups with adults who have vast amounts of experience living sober and can help with inevitable problems that arise along the way.) Teen programs, such as Teen-Anon, also afford the opportunity to mentor others, which is widely known to greatly improve chances for long-term sobriety.
Lastly, from a financial standpoint, 12-step participation has been shown to reduce medical costs among adolescents with a history of alcohol and other drug abuse. A 2012 study published in Drug and Alcohol Dependence by Mundt and colleagues examined 12-step attendance over a seven-year period with regard to medical care costs incurred during that time. Although no significant reduction of health care costs was notable over the first year, 12-step attendance was associated with an incremental cost-reduction rate of 4.7 percent, which translated into a medical care cost savings of $145 per person for each meeting attended over seven years. That is quite a savings, not to mention the tremendous suffering associated with illness that the family is spared.
Patient and family education
Meeting attendance at 12-step or other support groups is recommended because, the more people who stay sober long-term and attend such meetings regularly, the stronger the positive influence on the attendees. Yet simply recommending meetings doesn’t work unless the teen and his or her family understand why it is so important. Some key elements to include in patient and family education include:
1. Alcoholics and Narcotics Anonymous: (AA and NA) and Al-Anon meetings are great places for families to start. Millions of people of all ages have recovered through these groups. When people regularly attend AA/NA meetings, they find themselves part of a vast network of support. Members attend regularly, even after 10, 20 or 40 years after recovering from their addictive behavior. This is partly because of the friendships they make, but mainly because it is proven to keep them sober, and it works.
2. Teen-Anon: Teen-Anon is a group of teens and young adults who are recovering from substance use disorders. Many teens find it very relieving to meet other young people who are enjoying sobriety. Most meetings have an overall upbeat, positive energy. Other non-12-step support groups exist as well, such as SMART Recovery. Long-term data are not yet available on these non-12-step programs, but any social support is better than none.
3. The all-important sponsor: The mentor/sponsor is someone who has done the 12 steps and is willing to provide guidance through the process. This person should be someone with whom the teen feels comfortable and, ideally, trusts and admires. However, completing the steps promptly is more important than fussing over finding the perfect person or how to go about the process. Dragging it out for months on end is all too common, and people relapse and die in the meantime. Encourage your teen to find someone and get it done.
4. Engagement: The more after-meeting chat, the better, because that is when friendships are formed. A study published in 1999 in The American Journal of Drug and Alcohol Abuse by Fiorentine examined qualities of support groups that had the lowest relapse rates over two years. Successful groups had members who formed friendships that extended beyond the group, participated in group special events and activities like outreach, volunteering and fundraising. Developing lasting friendships in a sober support group community is the cornerstone of lasting recovery.
5. Maintenance: Successful transition from treatment to a new, healthy lifestyle with adequate support depends on a consistent program of recovery. Self-care and supportive care measures must be exercised on a daily basis over time. The positive changes teens experience during this process reinforce healthy, positive behaviors.
Teens who are transitioning from residential treatment for substance abuse face many challenges. Healthy lifestyle habits and relapse prevention techniques incorporated during treatment must be continued long-term. Aftercare plans should be individually constructed prior to discharge to help facilitate permanent change. Self-care habits are built into daily schedules and provide the best defense against relapse. Fully engaging in a 12-step program or other form of spiritual and social support also helps ensure ongoing sobriety. Teens and families need to be educated on and exposed to 12-step and social support groups prior to discharge to facilitate continued sobriety one day at a time.
The Sovereign Health Group Adolescent Program is dedicated to the long-term sobriety of every adolescent. When substance abuse is discontinued at a young age, brain and mental health can improve and even normalize. That is why Sovereign offers individualized treatment programs and aftercare plans that help teens and their families recover their health and relationships and move forward together toward a bright future.
Written by Dana Connolly, Ph.D., Sovereign Health Group writer