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06-16 Elements of successful adolescent substance abuse treatment, part 1

Elements of successful adolescent substance abuse treatment, part 1

Substance use problems in teenagers have become an epidemic. American adolescents and young adults ages 12 to 29 need help with drug and alcohol problems, according to the 2013 National Survey on Drug Use and Health. A study of adults needing treatment for drug or alcohol problems showed that 90 percent started using before the age of 18, and half before 15. This staggering fact could be because the adolescent brain is not fully developed until ages 22 to 24, so it might be more vulnerable to the effects of drugs and alcohol. Prompt and effective intervention is, therefore, particularly crucial in this special population. In fact, it’s an emergency.

Treatment works

On the bright side, teens who receive early and comprehensive treatment with ongoing support can and do recover from substance abuse. Identification of underlying mental health problems during substance abuse treatment further improves chances of survival. There are research data that support treatment efficacy for adolescents.

The landmark 2001 DATOS-A study followed 1,732 adolescents for one year after treatment for substance use disorders. Significant reductions were found in marijuana use, heavy drinking, use of other illicit drugs, criminal activities and arrests one year after treatment. Adolescents reported better psychological adjustment in terms of reduced suicidal thoughts and hostility, and increased self-esteem, better school attendance and average or better than average grades after treatment. Longer time in treatment was significantly related to lower drug use and lower arrest rates following treatment. Since 2001, the incorporation of cognitive-behavioral therapy and adjunctive medications have further improved outcomes.

Principles of effective treatment

In 2014, the National Institute of Drug Abuse (NIDA) published Principles of Adolescent Substance Use Disorder Treatment: A Research-Based Guide, which outlines recommendations for multifaceted treatment programs based on peer-reviewed scientific research studies. A comprehensive adolescent treatment program should include the following essential services: medical, HIV/AIDS, mental health, educational, legal, vocational and family services. Peer support is also an important part of treatment, particularly for teens. Peer support must also be included in aftercare to ensure ongoing long-term sobriety support.

The aftercare plan

Self-care and supportive care elements combine to provide a balance between structure and independence. Too much structure can result in rebellious adolescent behavior, whereas too much independence can result in reversion to maladaptive behaviors.

Centers that offer individualized treatment work with the patients and families to construct and facilitate a successful discharge plan. Teens must be included in both their relapse prevention plan and their aftercare plan. Signing each in the form of a contract between patient and provider is also helpful. New lifestyle habits are gradually introduced over the course of treatment.

Self-care must include a regular sleeping, eating and exercising schedule. These activities need to be allotted specific times in the aftercare schedule. Patient education elements to include in the discharge plan are discussed below.

  • Sleep: The body repairs itself during sleep. Yet sleep disturbances can continue for months after stopping alcohol and drug use. Patient education measures for sleep include relaxation techniques and importance of bedtime rituals. When insomnia medication is prescribed, drug information and follow-up physician appointments must be given.
  • Nutrition: Next, dietary recommendation need to be reviewed. Patients in early recovery are generally malnourished. Sugar cravings are common due to the dopaminergic stimulation of the reward center of the brain by sugar and other addictive substances. Dietary counseling should include elements of a nutritious diet and avoidance of foods and drinks with high sugar content. Healthy snacks and meal plans should be discussed. Families should be encouraged to follow the same recommendations to support their teen through the recovery process.
  • Exercise: Daily exercise is a well-established adjunctive treatment for patients with depression, anxiety, psychosis and mood disorders. A review of the literature suggests exercise also decreases craving and drinking behavior in patients with substance use disorders. Exercise also increases oxygen delivery to the brain, liver and heart and promotes healing.

Supportive care should continue for at least the first year and often includes the following:

  • Intensive outpatient or partial outpatient treatment program
  • Psychologist/therapist
  • Family therapy
  • Psychiatrist
  • Medical management
  • Support group/12-step program with sober adult mentors
  • Support group/12-step program for dual-diagnosis, LGBT, gender-specific, addiction-specific groups
  • Teen peer support groups/12-step program for teens
  • Support group/12-step program for parents and siblings of affected teen

Before and at the time of discharge from residential treatment, lifestyle changes must be incorporated immediately. By the time of discharge, most teens have been counseled extensively on how to prevent relapse. Techniques such as avoiding people, places and things associated with drinking/using drugs have usually been thoroughly rehearsed in therapy sessions. A practical aftercare plan includes a detailed schedule for which all time is accounted. The aftercare plan will be discussed in detail in Adolescent substance abuse treatment: Part II. Elements of successful aftercare.

Seek treatment early

Substance use disorders in adolescents are quite common and can result in permanent brain damage over time. Treatment has been shown to be effective in the young, with earlier treatment resulting in longer sobriety and fewer deaths. Residential treatment generally includes detoxification, followed by comprehensive assessment, therapy and lifestyle modifications. A supportive aftercare plan, including lifestyle changes, is crucial for lasting sobriety.

At Sovereign Health Rancho San Diego, helping youth achieve and maintain sobriety is the primary focus. Because adolescents and young adults are particularly vulnerable to adverse brain effects from substance use, Sovereign incorporates brain wellness into its treatment programs. Sovereign maximizes the residential stay with therapeutic interventions and aftercare preparation. To learn more, please call 866-577-3633.

Written by Dana Connolly, Ph.D., Sovereign Health Group writer

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