Finding Quality Treatment for Adolescents

 

Finding the Right Approach

Like other medical conditions, substance use disorder (SUD) treatment must be strong enough and long enough to effectively treat the disease. The National Institute on Drug Abuse(NIDA) uses the analogy of a bacterial infection, which requires antibiotics taken at a high enough dose and for a long enough period of time to kill all the bacteria. This means that patients might need to continue taking medication even after their symptoms are gone—otherwise the infection might come back and be harder to fight.

 

The same is true of SUDs. Insufficient treatment increases the risk that adolescents will return to substance use, leading them to feel hopeless about their condition and the benefits of treatment. This cycle into and out of treatment also might bias those supporting adolescents—friends, family members or the referring juvenile justice system, against further investing in these programs.

 

There are many different treatment options for youth with a SUD, and the level of care and setting should be chosen following an assessment of each adolescent’s individual needs. The American Society of Addiction Medicine (ASAM) has guidelines to assess adolescent patients and help them and their doctors decide the type and length of treatment that is best for them. assessments in six areas:

 

  • Intoxication level and withdrawal potential

  • Presence of other medical conditions

  • Presence of other emotional, behavioral or cognitive conditions

  • Readiness or motivation to change

  • Risk of relapse or continued drug use

  • Recovery environment, including family, peers, school and legal system



What to ask your Doctor

 

Ask your doctor the following questions to make sure they can help you identify the right kind of treatment for your child.

 

  • Are they trained to diagnose addiction?

  • If your doctor cannot complete a comprehensive assessment, can he or she refer you to an addiction physician specialist?

  • Can he or she stay involved and coordinate the treatment with a child’s addiction treatment providers?

  • Has he or she been trained to assess children for other mental illnesses?

  • Has he or she been trained to determine the right level of care based on the severity of a child’s substance use problems?

 

Identifying Quality Adolescent Treatment

Addiction Physician Specialists

Adolescents with problematic substance use should be assessed by doctors who specialize in addiction. This includes addiction medicine physicians, doctors who have advanced training or education in addiction treatment, or addiction psychiatrists, doctors who specialize in psychiatry and also have advanced training in addiction treatment.

Addiction Treatment Teams

While doctors, or in some cases clinical psychologists trained in addiction treatment, should coordinate addiction treatment, other health care professionals can play an important role. Addiction treatment teams may include:

  • Primary care doctors

  • Addiction medicine physicians or addiction psychiatrists

  • Licensed clinical psychologists

  • Master’s-level licensed clinical psychologists and addiction counselors

  • Licensed clinical social workers

  • Licensed clinical mental health counselors

  • Substance abuse counselors

  • Credentialed alcoholism and substance abuse counselors

  • Certified drug and alcohol counselors

  • Licensed alcohol and drug counselors

 

Questions to Ask When Looking for Treatment

National Institute on Drug Abuse (NIDA) recommends asking five questions about treatment:

  • Does the program use treatments backed by scientific evidence?

  • Does the program tailor treatment to the needs of each patient?

  • Does the program adapt treatment as the patient's needs change?

  • Is the duration of treatment sufficient?

  • How do 12-step or similar recovery support programs fit into addiction treatment?

 

Assessing Residential Treatment Settings

Criteria to keep in mind when looking for inpatient treatment include:

  • To ensure an experienced doctor is supervising patient care, an addiction medicine physician or addiction psychiatrist should be on staff full time.

  • Evidence-based therapies should be offered regularly, or at least 3 hours per week.

  • Expensive programs might not be evidence-based, or might offer extra services that have not been demonstrated to effectively treat addiction.

  • Some programs expel people who relapse during treatment; as relapse is part of the disease of addiction, look for providers who do not have these policies in place.

  • Treatment facilities should be licenced by the state to ensure they meet basic quality and safety requirements and/or accredited by a national organization that reviews facilities for compliance with standards of care and quality improvements. State licensing and accreditation does not guarantee the treatment offered is evidence-based.

 

Possible Treatment Settings  

Outpatient/Intensive Outpatient

Outpatient treatment is the most common approach to adolescent SUD. The treatment offered varies in its intensity, from once or twice a week to three or more times a week for at least three hours daily. It can meet the needs of youth with less severe addictions, few additional mental health problems and a supportive living environment. While therapy can be in an individual or group format, research suggests that group therapy can carry certain risks as some youth may glorify substance use and undermine the recovery goals of others in the group. Many adolescent outpatient treatment programs also include family interventions.

 

Partial Hospitalization

Also know as “day treatment,” partial hospitalization provides care to adolescents for four to six hours daily, at least five days a week. This higher level of care is best for youth with more severe substance use disorders who are safe living at home.

 

Residential/Inpatient Treatment

Adolescents with a severe SUD are typically referred to short- or long-term, 24-hour residential treatment. This resource-intense care can benefit youth with complex psychiatric or medical problems or family issues. Therapeutic communities, a common, long-term model, uses different techniques to “resocialize” adolescents, helping them to develop personal and social responsibility and new coping skills. It also involves all the members of the community, including residents and staff and family members if nearby, as active participants in treatment.

 

  • 1. Early Identification and Intervention Are Key
    Given the long-lasting effects of substances on the developing brain, it is critical to address substance use as early as possible. Most adults who develop a SUD started using substances before the age of 18. Risky behaviors that lead to substance use can also affect family bonding, positive peer relationships and school performance.
  • 2. Interventions Can Benefit All Adolescents
    Any substance use by young people is problematic, even if it appears on the surface to be “age-appropriate” experimentation. It exposes young people to the dangers posed to by the substance itself, risky behaviors associated with substance use, and increases their chances of developing a SUD later in life.
  • 3. Annual Medical Exams Should Screen Adolescents for Drug Use
    There are standardized screening tools that pediatricians, dentists, emergency room doctors, psychiatrists and other clinicians can use to assess a patient’s substance use. If an SUD is identified, doctors can determine its severity, provide a brief intervention or refer the teen to a substance use disorder treatment program.
  • 4. Legal Interventions or Family Pressure Can Support Treatment
    Even though they need help, adolescents with SUDs almost never seek treatment on their own. Research shows that mandatory treatment can be effective.
  • 5. Tailored Treatment Is Essential for Adolescents
    A comprehensive evaluation is used to assess an adolescent’s level of psychological development, relationships with family and peers, academic success, pro-social behavior, cultural and ethnic identity, and any special physical or behavioral issues. These factors should be used in developing a personalized treatment plan for each patient.
  • 6. Treatment Should Address the Whole Person
    Treatment that focuses only on an adolescent’s substance use is less likely to be successful. Instead, broader life needs, such as those related to medical, psychological and social well-being, as well as housing, school, transportation and legal services, should simultaneously be addressed.
  • 7. Behavioral Therapies Are Effective
    Behavioral therapies can motivate adolescents to refrain from substance use. These treatments should focus on building skills to deal with triggers, help them resist drug use, replace drug use with constructive and rewarding activities, improve problem-solving skills, and facilitate stronger interpersonal relationships.
  • 8. Families and Communities Are Important
    Several evidence-based interventions for adolescent SUDs seek to strengthen family relationships by improving communication and improving family members’ ability to support abstinence from drugs. In addition, members of the community (such as school counselors, parents, peers and mentors) can encourage young people who need help to start treatment—and support their recovery along the way.
  • 9. Identify and Treat Other Mental Health Conditions
    Adolescents who use substances should be assessed for other psychiatric disorders, including depression, anxiety disorders, attention-deficit hyperactivity disorder (ADHD), oppositional defiant disorder and conduct problems. Any additional treatment for comorbid conditions should be integrated with the SUD treatment.
  • 10. Assess Violence, Child Abuse and Suicide Risk
    Physical, emotional and/or sexual abuse or other trauma is common among adolescents using substances. Social and protective services should be contacted if abuse is suspected.
  • 11. Monitor Substance Use During Treatment
    Recovering adolescents may relapse or reinitiate drug or alcohol use. Some triggers include mental stress and social situations associated with prior substance use. Undetected relapse progresses to more serious consequences and thus should be identified early and addressed through adjustments in an individual’s treatment plan.
  • 12. Adequate and Continued Treatment Is Critical
    Studies show that the outcomes of substance use disorder treatment are better when people stay in treatment for three months or more. Additionally, many adolescents benefit from continuing care after treatment such as substance use monitoring, home visits and family linkages to other services.
  • 13. Test Adolescents for Infectious Diseases
    Youth who use substances are at high risk of contracting sexually transmitted diseases and infections from shared needles. Testing for diseases such as HIV and hepatitis B and C should be a routine part of treatment. Substance use disorder treatment can reduce adolescents’ substance use, which has been shown to lower the likelihood of risky behaviors, and provide risk-reduction counseling to teach them skills to change their high-risk behaviors.
 

Medications for Treating Adolescent SUDs

Currently, few of the medications found to be effective in treating addiction to opioids, alcohol or nicotine in adults have been studied enough to be approved by the Food and Drug Administration (FDA) for adolescent treatment. The evidence for their effectiveness and safety for individuals under 18 is preliminary, and thus most can only be used “off-label” when treating adolescents.

Buprenorphine is an exception. The FDA approved the use of buprenorphine for patients 16 and older in 2002. Provider experience to date using buprenorphine to treat adolescent and young adult opioid dependence shows it is feasible in a community treatment settings. Parental involvement enhances adolescent compliance with medication adherence, which in turn, leads to higher treatment retention rates and fewer relapses. Additionally, youth who comply are more likely to engage in substance use counseling, which is recommended as part of a comprehensive treatment approach.

Compared to non‐opioid using youths, those using opioids have higher rates of relapse and outpatient treatment dropout and worse post‐residential treatment outcomes. The use of medication as part of a comprehensive treatment plan has the potential to improve outcomes and is increasingly accepted by patients and their families.

Policies, attitudes and messages that prevent adolescents from accessing medications that can effectively treat their substance use disorder put their health at risk. Youth have lower overall rates of treatment retention when compared with adults, making the delivery of developmentally appropriate treatment imperative to support their recovery.

 

Supporting Adolescents in Recovery

Adolescents can benefit from recovery support services that are culturally relevant and tailored to meet their individual needs, including:

  • Assertive Continuing Care

  • Mutual Aid Groups

  • Peer Recovery Support Services

  • Recovery High Schools and Collegiate Recovery Programs

These programs offer a community setting where recovering youth can share experiences, provide mutual support and reinforce their substance-free lifestyle. They are not a substitute for treatment.

 

Assertive Continuing Care (ACC)

Clinicians provide home-based, assertive continuing care to help adolescents and their caregivers learn problem-solving and communication skills that promote their social engagement. It is intended for adolescents who have completed Adolescent Community Reinforcement Approach (A-CRA) therapy and combines A-CRA with assertive case management services, including multidisciplinary teams, round-the-clock coverage and assertive outreach.

 

Mutual Aid Groups

Mutual Aid groups include the 12-step programs Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), SMART Recovery 4-Point Program®, among others. Some 12-step fellowships have meetings and conventions specific to young people, for example YPAA or Young People in AA. These groups bring people in recovery together through weekly meetings in a community setting to share experiences and offer support. A set of principles guide 12-step groups, such as acknowledging: recovery cannot be sustained by willpower alone; the value in one person in recovery helping another; and the spiritual, emotional, and physical parts of recovery. Adolescents who have recently completed or are in substance use disorder treatment can benefit from being part of a peer group supportive of recovery efforts and attitudes.

 

Peer Recovery Support Services

Peer recovery support services connect adolescents in recovery with peer specialists who have experienced addiction, achieved recovery and are trained to support others in their recovery process. These services can be provided in individual or group settings. Peer specialists serve as mentors and can help recovering adolescents build new friendships and facilitate social networks through drug- and alcohol-free community-building activities.

 

Recovery High Schools and Collegiate Recovery Programs

Recovery high schools are designed to meet the needs of students recovering from substance use disorders. Though they are often part of another school, students in recovery take classes apart from other students through scheduling or the use of separate spaces. These high schools also offer academic and recovery support services.

A growing number of colleges and universities offer collegiate recovery programming on campuses across the country. These programs aim to support students wishing to maintain recovery and can help teens who are considering applying to school.

 

Resources:

Fisher E. A. (2014). Recovery Supports for Young People: What Do Existing Supports Reveal About the Recovery Environment?. PJE. Peabody journal of education, 89(2), 258-270.

 

Resources for Patients and Families

 

Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse: U.S. Preventive Services Task Force Recommendation Statement

 

Family Resource Center Seeking Drug Abuse Treatment: Know What To Ask

 

Resources for Providers and Health Care Systems

 

National Institute on Drug Abuse (NIDA) Adolescent Treatment Guide

 

Substance Abuse and Mental Health Services Administration (SAMHSA) TIPs Related to Adolescent Treatment