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Adolescent SubstanceAbuse Best
Practices for Better Outcomes

• Geoff Wilson, LCSW, CADC

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Average Age of.

• Average age adult substance abuser reports as
  their age of onset of drug and/or alcohol
  use_____?
• Average age of adults currently in
  inpatient/residential care in KY____?
• Houston, we have a problem!!

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Why the Focus on Adolescents?

• Experimentation is already going on!! Nearly one
  in three (29) adolescents has experimented with
  illegal drugs, and 41 have consumed alcohol by
  the time they finish 8th grade.
• One in five American adolescents between the ages
  of 12 and 17 engages in abusive/dependent or
  problematic use of illicit drugs or alcohol.

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Why the Focus on Adolescents?

• In the US by age 16, 25 of all youth have
  experienced a traumatic event.
• Up to 59 of young people with PTSD subsequently
  develop substance abuse problems.
• In surveys of adolescents receiving treatment for
  substance abuse, more than 70 of patients had a
  history of trauma exposure!!

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Adolescent Treatment Gap

• Only 10 percent of 12- to 17-year-olds needing
  substance abuse treatment actually receive any
  services. When they do get treatment, it is often
  for different reasons than adults. By far, the
  largest proportion of adolescents who receive
  treatment are referred by some form of the
  juvenile justice system. (NASDUH, 2012 Survey).

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What Typically Gets Them into Treatment?

• Marijuana use among teens rose in 2012 for the
  fifth straight year. Daily marijuana use among
  high school seniors is now at a 30 year peak.
  Put another way, 1 in every 15 high school
  seniors is smoking pot an a daily or near daily
  basis
• Most adolescents do not recognize their substance
  use as a problem and are being mandated to
  treatment (and are not happy about it!!)

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Adolescent Development

• Adolescence is a 10-20 year period of transition
  from dependence to independence.
• Normal adolescence is characterized by.
• Increase in conflicts with family members.
• Desire to be with ones friends.
• Resistance to messages from authority.
• Irritability and risk-taking.
• Proclamations of sheer boredom.
• (Ken Winters, Ph.D., 2007).

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Adolescent Brain Development

• Four Areas to Focus On
• 1) Mid-Brain or Old Brain
• The way-station for incoming sensory information
  on the way to the cortex.
• Mid-Brain is the SURVIVAL Brain
• What handles the next thirty seconds.
• Plays major role in how brain reacts to STRESS!!!
• Drugs and Alcohol can become SURVIVAL.

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Adolescent Brain Development

• 2) Pre-Frontal Cortex
• Seat of the self and personality
• Center for love, morality, decency,
  responsibility, spirituality
• Conscious
• If it is immature, its the neurobiological
  explanation for why teenagers show poor judgment
  and act before thinking.
• Average age of maturity?________

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Adolescent Brain Development

• 3) Nucleus Accumbens
• It directs motor behavior.
• Is responsible for how much effort we will expand
  in order to seek rewards, Pay Offs.
• If it is immature, adolescents will lean toward
  activities that require little effort, yet
  produce high Pay Off, like video games, drugs,
  etc.

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Adolescent Brain Development

• 4) Amygdala
• It integrates our emotional reactions to
  pleasurable and aversive experiences.
• Lights up for food, sex, survival.
• Lights up for cues to using and for using drugs.
• As it develops, two distinct behavioral effects
  tend to occur
• Teenagers react explosively to situations
  rather than calm.
• Teenagers have a propensity to misread
  neutral facial expressions as being
  angry/disappointed.

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Engagement and the Pre-treatment Process.

• Adolescents need the opportunity to examine the
  correlation between their drug/alcohol use and
  the life consequences they are experiencing.
• Families also need the opportunity to examine the
  effect their adolescents drug/alcohol use is
  having on them.
• This opportunity may be effectively implemented
  on an early intervention/outpatient/intensive-outp
  atient basis.

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The Pre-Treatment Process and Stages of Change

• Many adolescents will decrease or discontinue
  substance use by either experiencing a
  personal/significant life event or by maturing
  out.
• However, WE may see adolescents that are more
  severe cases, with more co-morbidity.
• For treatment to be effective, adolescents need
  influence to move through stages of change to
  achieve healthy behavior.

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Stages of Change

• Pre-Contemplation Drug Problem? My_______ has
  the problem!
• Contemplation Maybe.but Im not as bad as
  JohnnyIm not an addict!
• Preparation I have to see Geoff who!.........on
  a !! Saturday!!
• Action Im in counseling..it actually helps!
• Maintenance Man, my folks actually trust me
  now. No way am I using!
• Relapse I tested positive?? No Way! Wait.I
  was in a car with people smoking weed, thats
  it!!

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Addressing the Needs of Adolescents with
Co-occurring Trauma and Substance Abuse

• These teens frequently have difficulty entering
  or staying involved in treatment services.
• Few facilities offer integrated treatment, fewer
  training programs provide clinicians with the
  education, and fewer professionals have training
  across both fields.
• It is important to look beyond the immediate
  circumstances of the youths substance use and
  pay attention to his or her trauma history.

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Engaging Adolescents in the Treatment Process

• Clients engagement the strongest determinant of
  outcome.
• The therapeutic alliance often mediates client
  engagement.
• Allegiance Believing in the work you do!
• Quality of the relationship more potent predictor
  of outcome than theoretical orientation,
  experience level, or professional discipline (S.
  Miller).

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Motivational Enhancement Therapy (MET)

• Express Empathy
• Develop Discrepancy
• Avoid Argumentation
• Roll With Resistance
• Support Self-Efficacy
• Work with the Adolescents own specific reasons
  to change-I need to get that !_at_ out of my
  life!!
• Understanding ambivalence and using reflective
  listening.

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The Seven Challenges

• Developed by Dr. Robert Schwebel
• Guides youth through a process of weighing the
  benefits vs. harm of their drug use and behavior.
• Starts where the youth are, as an alternative to
  a rush to abstinence.
• Looks at what youth like about substances, as
  well as their trauma history
• Encourages and supports flights into abstinence
• Recognizes that teens are generally dragged into
  treatment and in early stage of change
• Manualized treatment w consistent therapist
  feedback. (www.sevenchallenges.com)

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What about AA with Teens?

• Although not a lot of research, 67 of youth
  facilities incorporate 12 Step principles (Drug
  Strategies, 2009)
• John F. Kelly, Ph.D.-Harvard Addiction Research
  Institute
• Top 3 Aspects Youth Acknowledged
• Universality (Im Not Alone!)
• Positive Attention (People Care!)
• Instillation of Hope (I Can Change!)
• Least helpful aspect-The content!!

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Family Systems

• 8.3 million children in the US, approximately
  11, live with at least one parent who is in need
  of treatment for alcohol and drug dependency
  (CSAT).
• Children of addiction are at a significantly
  greater risk for
• Mental illness/Substance abuse
• Physical health Issues/Trauma
• Learning problems, including difficulty with
  cognitive verbal skills, conceptual reasoning,
  and abstract thinking.

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Family Treatment

• It is essential and we must be aware of the
  family system challenges most adolescents face
  when trying to stay sober.
• My Home Life For the most part, adolescents
  cant choose where they live during/after
  treatment.
• Home may consist of parents, siblings, extended
  family that also use drugs and alcohol. Often
  family members stage of change is
  Pre-contemplation Mea problem?

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Family Participation

• First contact with families should involve
• High degree of empathy.
• Assessment Why do you think Johnny uses drugs?
• Reflection for clarifying.
• Determining who should be involved.
• Negotiation for involvement.

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Sources of Evidence-Based Information on the Web

• www.attcnetwork.org/explore/priorityareas/science/
  ebp
• www.nida.nih.gov
• www.nrepp.samhsa.gov
• www.niaaa.nih.gov
• www.asam.org
• www.cdc.gov/idu/

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Wrap Up!!

• Questions, comments, and concerns???
• Geoff Wilson, LCSW, CADC
• The Ridge Behavioral Health System
• 3050 Rio Dosa Drive
• Lexington, KY 40509
• 859.268.6448/859.229.5722
• geoff.wilson_at_uhsinc.com