Transcript Treatment For Teens with Substance Abuse

Treatment For Adolescence
with Substance Abuse
By Matthew Dahlin
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)
Treatment Centers
• Outpatient
• Inpatient
– Short term (more time doing therapy, 50-70 days)
– Long term (6-12 months)
(7,9)
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)
Main Study
The 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)
Main Study
(5)
Main Study Results
(5)
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)
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)
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)
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)
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)
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)
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+)
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)
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)
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)
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
Difficulties in Research
• Figuring out what specific components really
make the change (would need a controlled
experiment)
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
Get Involved
• Many RTC’s and Wilderness programs all over
Utah
• Not having experience abusing substances will
NOT negatively effect your involvement
(4)
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
(6th ed).
10)Erikson. E. H. (1950). Childhood and Society. New York. W.W. Norton.