Excerpt: Substance Use Disorder Treatment and Adolescents

In 1997, substance use among 12- to 17-year-old children rose to 11.4 percent with illicit drug use among 12- and 13-year-olds increasing from 2.2 to 3.8 percent, according to the 1997 National Household Survey on Drug Abuse conducted by the Substance Abuse and Mental Health Services Administration. Moreover, perceived risk of harm from substance use is falling while the availability of drugs is climbing. These trends indicate a major national problem, especially as the social and economic costs of adolescent substance use are becoming better understood.

The onset of substance use is occurring at younger ages, resulting in more adolescents entering treatment for substance use disorders with greater developmental deficits and perhaps much greater neurological deficits than have been observed in the past. Other consequences of substance use and abuse include alcohol- and drug-related traffic accidents, delinquency, sexually risky behavior, and psychiatric disorders.

Adolescent users differ from adults in many ways. Their drug and alcohol use often stems from different causes, and they have even more trouble projecting the consequences of their use into the future. In treatment, adolescents must be approached differently than adults because of their unique developmental issues, differences in their values and belief systems, and environmental considerations (e.g., strong peer influences).

At a physical level, adolescents tend to have smaller body sizes and lower tolerances, putting them at greater risk for alcohol-related problems even at lower levels of consumption.

The use of substances may also compromise an adolescent's mental and emotional development from youth to adulthood because substance use interferes with how people approach and experience interactions.

The treatment process must address the nuances of each adolescent's experience, including cognitive, emotional, physical, social, and moral development. An understanding of these changes will help treatment providers grasp why an adolescent uses substances and how substance use may become an integral part of an adolescent's identity.

Regardless of which specific model is used in treating young people, there are several points to remember when providing substance use disorder treatment: In addition to age, treatment for adolescents must take into account gender, ethnicity, disability status, stage of readiness to change, and cultural background. Some delay in normal cognitive and social-emotional development is often associated with substance use during adolescence. Treatment for adolescents should identify such delays and their connections to academic performance, self-esteem, or social interactions.

Programs should make every effort to involve the adolescent client's family because of its possible role in the origins of the problem and its ability to change the youth's environment. Although it may be necessary in certain geographic areas where availability of adolescent treatment programs is limited, using adult programs for treating youth is ill-advised. If this must occur, it should be done only with great caution and with alertness to inherent complications that may threaten effective treatment for these young people.

Many adolescents have explicitly or implicitly been coerced into attending treatment. Coercive pressure to seek treatment is not generally conducive to the behavior change process. Treatment providers should be sensitive to motivational barriers to change at the outset of intervention. Several strategies can be used for engaging reluctant clients to consider behavioral change.

Tailoring Treatment to The Adolescent

Adolescent substance use occurs with varying degrees of severity. The degree of substance involvement is an important determinant of treatment, as are any coexisting disorders, the family and peer environment, and the individual's stage of mental and emotional development.

This TIP, Treatment of Adolescents With Substance Use Disorders, updates TIP 4, published in 1993, and presents information on substance use disorder treatment for adolescent clients. Adolescents differ from adults both physiologically and emotionally as they make the transition from child to adult and, thus, require treatment adapted to their needs. The onset of substance use is occurring at younger ages, resulting in more adolescents entering treatment for substance use disorders than has been observed in the past. In order to treat this population effectively, treatment providers must address the issues that play significant roles in an adolescent's life, such as cognitive, emotional, physical, social, and moral development, and family and peer environment. This TIP focuses on ways to specialize treatment for adolescents, as well as on common and effective program components and approaches being used today.

Contents

Chapter 1 details the scope and complexity of the problem;
Chapter 2 presents factors to be considered when making treatment decisions; and Chapter 3 discusses successful program components.
Chapters 4, 5, and 6 describe the treatment approaches used in 12-Step-based programs, therapeutic communities, and family therapy respectively.
Chapter 7 discusses adolescents with distinctive treatment needs, such as those involved with the juvenile justice system.
An explanation of legal issues concerning Federal and State confidentiality laws appears in Chapter 8.