TIP 31 & 31 Adolescent ddictions Treatment

TIPs 31 and 32
Adolescents
Dr. Dawn-Elise Snipes, PhD, LMHC, CRC, NCC

Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC

Adolescent Development
Cognitive

◦ Early Adolescence
 Emphasizes immediate reactions to behavior
 May not be fully aware of later consequences
◦ Late Adolescence
 Greater use of inductive/deductive reasoning
 More introspective and more sensitive to later
consequences


Developmental Tasks
Family Independence

◦ Beginning rejection of parental guidelines
◦ Ambivalence about wishes
◦ Insistence on independence, privacy
◦ May have overt rebellion, limit
testing, withdrawal
Peers

◦ Early: Most often quot;bestquot; friend is same sex
◦ Late: Dating, risk taking, need to please
peers


Developmental Tasks cont…
School and Vocation

◦ Beginning to identify skills, interests
◦ Starting part-time job
Self Identity and Esteem

◦ Am I normal?
◦ Conformity--behavior that meets peer group
values
◦ Some continue to pursue group/peer
acceptance
◦ Some are able to reject group pressure if not
in self-interest


Professional Approach
Early Adolescents

◦ Provide firm, direct support
◦ Convey limits--simple concrete choices
◦ Do not align with parents, be an
objective caring adult
◦ Encourage transference (hero-worship)
◦ Sexual decisions--directly encourage to
wait
◦ Encourage parental presence in
clinic, but interview teen alone

Professional Approach cont…
Late Adolescence

◦ Be an objective sounding board (but let
adolescents solve own problems)
◦ Negotiate choices
◦ Be role model
◦ Don't get too much history (quot;grandiose
storiesquot;)
◦ Confront gently--about
consequences, responsibilities


Professional Approach cont…
◦ Consider quot;What gives them status in the
eyes of peers?quot;
◦ Use peer group sessions
◦ Adapt systems to crises, walk-
ins, impulsiveness, testing
◦ Ensure confidentiality
◦ Allow teens to seek care independently


Screening and Assessment


Screening and Assessment
Selection of instruments is guided by:

1. Reliability and validity of the tool
2. Its appropriateness to an adolescent
population
3. Type of settings in which the instrument
was developed
4. Intended purpose of the instrument


Features of Instruments
Short in duration

High test-retest reliability

Evidence of convergent validity (i.e., the

instrument is strongly correlated with
other instruments that purport to
measure similar constructs)
 Predictive validity (i.e. school
performance, relapse)
 Normed on adolescents
 Ability to measure meaningful behavioral
and attitude changes over time


Family Assessment
Adolescents may define family in

nontraditional ways.
 The law and society may define family in
ways that differ from the actual
experiences of youth.
 Cultural and ethnic differences in family
structures should be respected.
 The core problem may reside outside the
adolescent and the substance use is a
symptom.


Screening Indicators
Use during childhood or early

adolescence
Use before or during school

Peer involvement in use

Daily use of one or more substances

Parental substance abuse

Sudden change in school performance

Marked change in physical or mental

health
Risky activities

Truancy or running away


Goals of Screening
Determine severity of disorder

 Examine associated factors
 Make appropriate referrals


Assessment
More in-depth than screening

Document disorders and interactions

across all domains
 Identifies information to guide treatment
planning
◦ Strengths
◦ Social supports
◦ Motivation
Provides an opportunity for engagement

and motivational enhancement
 Is an ongoing process


Areas for Assessment
Substance use history

◦ Age of first use for each drug
◦ Frequency, intensity, duration
◦ Concurrent use
◦ Immediate and remote consequences of
use
◦ Family history of use
◦ Peer and family attitudes toward drug use


Areas for Assessment cont…
Mental health

◦ Family history
◦ Client’s history
◦ Present symptoms
◦ Past and present medication and/or
treatment and effects
◦ Coping skills and strengths
◦ Trauma
◦ Self-esteem
◦ Eating disorders


Physical health

◦ Current/past
◦ Current medications
◦ Family health history
◦ Housing
School experience

◦ Performance
◦ Attendance
◦ Enjoyment
◦ Learning disabilities


Social

◦ Peer relationships
◦ Changes in peer groups
◦ Interpersonal skills
◦ Neighborhood environment
◦ Gang involvement
◦ Pro-social activities
◦ Mentors/social supports
Sexual history

◦ Activity
◦ Orientation
◦ STDs/pregnancies

Juvenile justice involvement

 Developmental milestones and events
 Family history
◦ Parental relationships
◦ Involvement with DCF
◦ Home environment
Other strengths



Integrated Summary
Identifies the severity of all disorders

 Identifies (mitigating and
exacerbating) factors
 Identifies a corrective plan of action to
address these problem areas
 Details a plan to ensure that the
treatment plan is
individualized, implemented and
monitored
 Makes recommendations for referral

Integrated Summary cont…
Identifies a SPOC

 Describes how resources and services
of multiple agencies can best be
coordinated and integrated
 Recommend post-treatment services


Assessors
Trained in:

◦ Psych assessment
◦ SA assessment
◦ Developmental psychology
◦ Use of standardized tools


Legal Issues
Federal confidentiality regulations (42

C.F.R. 2.12(e))
 Disclosure without the adolescent's
consent in situations such as:
◦ medical emergencies
◦ child abuse reports
◦ program evaluations
◦ communications among staff
Programs may not communicate with the

parents of an adolescent unless they get
the adolescent's written consent.

Legal Issues cont…
The Federal regulations contain an

exception permitting a program director
to communicate with an adolescent's
parents without her consent when:
◦ The adolescent is applying for services
◦ The program director believes that the
adolescent does not have the capacity to
decide
◦ The program director believes the disclosure
is necessary due to a substantial threat to the
life or well-being of the adolescent or
someone else

Other exceptions:

◦ Information that does not reveal the client
as having a substance use disorder
◦ Information ordered by the court after a
hearing
◦ Medical emergencies
◦ Information regarding crimes on program
premises or against program personnel
◦ Information shared with an outside
agency that provides service

Other exceptions cont…

Information discussed among people within
o
the program
Information disclosed to
o
researchers, auditors, and evaluators with
appropriate Institutional Review Board review
and approval to ensure the protection of
program participants
Note: Always check with your legal counsel

in your state to ensure conformance with
state as well as federal laws

Issues in DJJ
Concurrent issues

◦ Physical or sexual abuse
◦ Psychological and emotional problems
◦ Poor performance in school
◦ Family difficulties
◦ Gang-related violence and involvement
◦ Living in neighborhoods where poverty
and low income have led to
communitywide despair and
hopelessness


Treating Adolescents
Adolescents are not little adults

 Drug and alcohol use often stems
from different causes
 They have trouble anticipating the
consequences of their use
 Must address
cognitive, emotional, physical, social
and moral development


Treating Adolescents cont…
Take into account

gender, ethnicity, disability status, stage
of readiness to change and cultural
background
 Identify and treat delays in normal
cognitive and social-emotional
development associated with substance
use during adolescence
 Involve the adolescent's family because
of:
◦ its possible role in the origins of the problem
◦ its ability to change the youth's environment
Be sensitive to motivational barriers


Treatment Planning
Identify biopsychosocial problems

 Identify attainable goals for those
issues
 Enhance strengths and resources to
meet those goals
 Specify objectives that are realistic
and measurable for each goal
 Describe interventions needed to
achieve objectives

Program Components
Orientation

 Daily scheduled on-site and off-site
activities
 Peer monitoring
 Conflict resolution
 Vocational Training


Program Levels
Detoxification

 Outpatient
 Intensive Outpatient
 Group Home/Residential
 Inpatient/Hospital Based
 Continuing Care


12 Steps for Adolescents
Providers treating adolescents in a 12-

Step-based program should bear the
following in mind:
◦ CoD are primary, multifaceted illnesses that
exist in people of all ages, including
adolescents
◦ Persons with CoD share a common
problem but have unique and separate
needs
◦ Once adolescents are informed in an
understandable way, they are capable of
helping others with guidance

12 Steps for Adolescents cont…
◦ Use of group therapy is well suited to
adolescents, who tend to rely heavily on
peer examples and approval
◦ The principles of recovery outlined by
AA/NA provide effective and proactive
tools for continuing recovery
◦ Once a person has lost control over his
use of substances as an
adolescent, returning to responsible and
legal use as an adult may require
additional help and support


Adolescents and the First 5
Steps
Focus on the first 5 steps during

treatment
◦ Step 1: We admitted we were powerless
over alcohol--that our lives had become
unmanageable.
 Assist adolescents in reviewing their SA history
and associate it with harmful consequences.
◦ Step 2: We came to believe that a Power
greater than ourselves could restore us to
sanity.
 Help adolescents with CoD to understand that
Step 2 refers to obtaining help to stop drug
seeking and use behavior.

Adolescents and the First 5
Steps cont…
◦ Step 3: We made a decision to turn our will
and our lives over to the care of God as we
understood Him.
 Using the phrase quot;Helping Powerquot; instead of
quot;Higher Powerquot; or “Good Orderly Direction” can
benefit some.
◦ Step 4: We made a searching and fearless
moral inventory of ourselves; Step 5: We
admitted to God, to ourselves, and to another
human being the exact nature of our wrongs.
 Steps 4 and 5 provide an opportunity to be
accepted by another person in spite of one's past
behaviors and to take a quot;personal inventoryquot; of
those past behaviors.


Staff Training
Treatment approaches specific to

adolescents and their families
 Family dynamics and family therapy
 Adolescent growth and development
 Sexual and physical abuse
 Gender issues
 Mental health problems
 Different cultural and ethnic values


Staff Training cont…
Psychopharmacology

Referral and community resources

Cognitive impairments

Legal matters Recreational and pro-

social activities
Group dynamics and group therapy

Suicidal behavior

Grief and loss

Management of oppositional and violent

behaviors

Staff Training cont…
Legal matters (custody and juvenile

justice concerns, child abuse and neglect
reporting requirements, duty-to-warn
issues)
Treatment planning and documentation

HIV/AIDS

Other health matters

(STDs, tuberculosis, hepatitis, nutrition)
Gangs

Drug dealing



Summary
Treating adolescents requires special

skills and training
Most adolescents begin use to cope or

receive external validation
Adolescents’ development is often

thwarted at the point of SA initiation
A strengths-based motivational approach

works well with older adolescents
Adolescents can be helped to develop

into healthy adults


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