Adolescents

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Adolescents

• Clinical Practice with Addictive Disorders

Renee Hillsman Tamara Robinson Tracy
Tarbutton Tammy Wilbanks
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Treatment Considerations
Individual Developmental Stages
Demographics
Family
Stages of Change
Community
School
Peer
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• View From Within The Whirlwind
• With adolescence, many kinds of development
  occur - physical, emotional, intellectual,
  academic, social and spiritual-and they dont
  always occur in tandem.
• Pipher, M. (1994). Reviving Ophelia saving the
  selves of adolescent girls. New York, NY
  Ballantine Books.

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• Family is the essential presence-
• the thing that never leaves you even if you have
  to leave it
• Buford, Bill (1955). The
  Family. New York Granta Books
• Detached - mall orphans
• Parental substance use
• Low affection/stability
• No Parental Monitoring

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• Schools are better at pulling weeds than at
  planting flowers
• Eisner, E. (1990). Who Decides What Schools
  Teach? Phi Delta Kappan 71 523-526.
• Islands of stability or arenas for battle?
• Negative school climate
• Traumatic experiences
• Rejection/isolation/exclusion/alienation

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• Every citizen shares the responsibility of
• creating communities in which
• all youth can thrive and grow.
• Seita, J.R. Brendtro, L.K. (2005). Kids
  who outwit adults.
• Complacent/permissive norms
• Drug availability
• Lack of neighborhood attachment
• Low socioeconomic status

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• And why does he hang out with his friends?
  Because any one of these kids would take a bat to
  your head if he asked them to. Its called
  loyalty
• Sean, Maguire, Will Huntings therapist,
  Good Will Hunting
• Peer influence a powerful social need
• Youth increase freedom from adult authority

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Rules of Engagement

• The Distrust Lens
• Do unto others
• vs.
• tit for tat
• Private Logic
• I am.
• Other people are
• The world is.
• Therefore I am.
• Flight/Fight/Fool

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• Adolescents need help from therapists in FINDING
  EXIT STRATEGIES from their problems that keep
  intact their sense of dignity

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Questions Teenagers Hate

• How does that make you feel?
• Do you think thats such a good idea?
• Why do you think you did that?

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How We End Up NOT Helping

• Thinking that CREDIBILITY LIKEABILITY or
  TRUSTWORTHINESS
• Soliciting the adolescents APPROVAL
• Presenting oneself as too helpful
• Being too careful THINK CANDOR AND CONNECTION
• Trying to mask the fact that youre stumped
• Trying to exert control over the therapeutic
  process

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Continuum of Use
Recreation User
Experimental User
Regular User
Prevention Intervention Treatment
Non-User
Abuser
Substance Dependent
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Adolescent Substance Use
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Signs of Drug Use

• Negative changes in schoolwork missing school or
  declining grades
• Increased secrecy about possessions of activities
• Use of incense, room deodorant or perfume to hide
  smoke or chemical odors
• Subtle changes in conversation with friends,
  e.g., more secretive, using coded language
• New friends
• Change in clothing choices new fascination with
  clothes that highlight drug use
• Increase in borrowing money
• Evidence of inhaling products and accessories,
  such as hairspray, nail polish, correction fluid,
  paper bags, common household products
• Bottles of eye drops, which may be used to mask
  bloodshot eyes or dilated pupils
• New use of mouthwash or breath mints to cover up
  the smell of alcohol
• Missing prescription drugs especially narcotics
  and mood stabilizers
• Lack of interest in personal appearance

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Consequences
Traffic Accidents
Juvenile Crime
Adolescent Substance Use
Developmental Problems
School-Related Problems
Physical/Mental Consequences
Risky Sexual Behavior
Delinquent Behavior
Future Use Disorder
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Treatment Setting
In-patient Hospitalization
Long-Term Residential
Partial Hospitalization
Insurance Managed Care Issues
Intensive Outpatient
Outpatient
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• Cognitive-Behavioral
• Problem-Solving
• Self-Monitoring
• Goal Setting
• Decision Making Skills

• Family-Based
• Behavioral Approach
• Contingency Contracting
• Family Management
• Parenting Strategies
• Communication Training
• Strategic and Structural
• Symptoms of the Family
• Restructuring Problematic
• Relationships
• Integrative Models
• Ecosystem Model

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Resources

• DiClemente, C.C. (2003). Addiction and change
  How addictions develop and addicted people
  recover. New York The Guilford Press.
• Edgette, J.S. (2006). Adolescent therapy that
  really works Helping kids who never asked for
  help in the first place. New York, NY W.W.
  Norton.
• Sampl, S Kadden, R. (2001) Motivational
  enhancement and behavioral therapy for adolescent
  cannabis users 5 sessions. Retrieved June 1,
  2007 from http//www.kap.samhsa.gov/products/manua
  ls/cyt/pdfs/cyt1.pdf.
• Seita, J.R. Brendtro, L.K. (2005). Kids who
  outwit adults.
• Bloomington, ID National Education Services.
• Straussner, S. L. (Ed.). (2004). Clinical work
  with substance-abusing clients. 2nd ed. New York
  The Guilford Press. Edgette, J.S. (2006).
  Adolescent therapy that really works Helping
  kids who never asked for help in the first place.
  New York, NY W.W. Norton.

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Adolescents

• Clinical Practice with Addictive Disorders

Renee Hillsman Tamara Robinson Tracy
Tarbutton Tammy Wilbanks