Research has shown that early onset substance use problems can predict continuing substance use problems in adulthood. Individuals who seek help at the earliest stages of drug use often experience more favorable outcomes, thus highlighting the importance of working with adolescents who are beginning their involvement with drugs. While several approaches to treating adolescent substance abuse have been evaluated, the majority of these approaches have little support for use with adolescents. Additionally, while therapy appears to help, little evidence is available to suggest that one therapy is more effective than another, and even less is known about what therapy works for different populations, including ethnic or cultural groups, adolescents with co-morbid disorders, and male versus females. Among outpatient treatment modalities, most include family therapy, 12-step/self-help, behavioral/cognitive behavioral individual group, and motivational interventions.
Family therapy is the most researched treatment modality for adolescent substance abuse. Several reviews conclude that family therapy is more effective than other forms of non-family outpatient treatment, including individual counseling, group therapy, and family drug education.
Multisystemic therapy is an intensive (up to 60 hours) home based intervention for families that addresses multiple systems, including schools, peers, groups, parenting skills, communication skills, family relations, and other cognitive behavioral changes. The therapy approach incorporates structural and strategic family therapy and cognitive behavioral therapy.
Multidimensional family therapy (MDFT) is recognized as one of the most promising interventions for adolescent drug abuse. MDFT combines drug counseling with multiple systems assessment and intervention, both inside and outside the family. This approach is developmentally and ecologically oriented, considering the environmental and individual systems in which the adolescent resides.
Brief strategic family therapy (BSFT) was developed and designed for Hispanic/Latino families with youth having behavioral problems. BSFT is structured to meet with the entire family once weekly for eight to twelve weeks and includes specialized engagement strategies, effectiveness of which has been evaluated and shown in several studies. The intervention is manualized and was recently reviewed.
Few studies have compared family therapies with one another, and no evidence is available to suggest that one type of family therapy is superior to another. Indeed, family therapies may be more similar than different because they share the underlying conceptual framework that individual problems are best understood and addressed at the level of family interaction. More recently the field has seen an increase in integrative or combined interventions that include a combination of treatment contexts (individual and family therapy) or theoretical orientations (family systems theory combined with behavioral intervention).
The family therapy field continues to evolve with process analysis that examines therapeutic alliance, changes in parenting practices, and underlying connections between changes in family functioning and specific adolescent problem behaviors. In summarizing, outcome research has provided support for the positive impact of family therapy on reducing alcohol and drug use, increasing engagement and retention in treatment, reducing internalizing and externalizing problems, improving family interaction, and increasing the adolescent’s involvement in school.
12-step Programs and Substance Using Youth
Professional treatment approaches targeting adolescent substance related problems often incorporate the 12-step philosophy and practices of community mutual help organization, such as Alcoholics Anonymous (AA) and Narcotic Anonymous (NA). In theory, community mutual help resources, such as AA and NA, possess certain elements that make them attractive as an adjunct to formal care. For instance, meetings are available in most communities several times a day, notably at times of high relapse-risk, such as evening and weekends. This provides a degree of flexibility that is not available in professional settings. Moreover, outside of regular meetings, sponsors and other fellowship members often make themselves available “on demand” (e.g., by phone) seven days a week at any time of day or night because a major precursor to adolescent relapse is association with pre-treatment substance using friends. The socially oriented organizational structure of AA and NA could serve as a useful antidote by providing access to a new recovery specific social network. Also of note is the fact that AA and NA groups can be attended free of charge for as long as an individual desires; thus, these organizations could be helpful for substance involved youth with an increasingly cost constricting managed care environment. Conversely, developmentally related differences between adolescents and adults suggest that 12-step fellowships may not be an ideal fit for all youth. For instance, compared to their older counterparts for whom AA was originally devised, adolescents on average possess less addiction severity and related sequelae and lower substance-related problem recognition and motivation for abstinence. They are also significantly younger relative to the majority of the other AA and NA members. Furthermore, some youth treated for substance use may feel uncomfortable with the degree of spiritual/religious emphasis in the AA/NA. Conceivably, such differences might signify a poor fit with 12-step fellowship’s unwavering emphasis on abstinence and spiritual growth.
Treatment approaches vary because adolescents and their families, along with the adolescent substance use, enter in with other problems as well. Irrespective of the approach utilized, it is necessary for clinicians, youth advocates, program directors, and administrators to fully understand that, even though therapy approaches designate a certain amount of treatment time alone with the adolescent, one must never forget the clinical adage in adolescent work, “The way you help a kid is by helping the family.”
References available upon Requests
Fred Dyer, PhD., CADC, is an internationally recognized speaker, trainer, author and consultant who services juvenile justice/detention/ residential programs, child welfare/foster care agencies, child and adolescent residential facilities, mental health facilities and adolescent substance abuse prevention programs in the areas of implementation and utilization of evidence-based, gender-responsive, culturally competent, and developmentally and age appropriate practices. He can be reached at firstname.lastname@example.org.