Treating Adolescent Substance Abuse
The first fundamental element of an effective treatment program for adolescent substance abusers is a sound rationale for diagnosis and treatment. Nay and Ross (1993, pp.317) explain: “Efficacious assessment tools and intervention schemes emerge only from a sound conceptual framework…from a sound conceptualization of the variables that instigate and maintain drug use…a conceptual model for better understanding the phenomenon of adolescent substance abuse and, more importantly with a sound framework for intervention.” Thus, only from a sound rationale can assessment strategies and clearly defined treatment goals and objectives be formulated.
The second fundamental element entails the development and employment of sound screening, assessment, and diagnostic procedures. Nay and Ross (1993, p. 317) further explain: “A variety of events may compel a reasonable well-adjusted youth from a functional family to initiate drug use…Given the myriad of possible combinations of person and life factors that may combine to influence a child’s use of chemicals, a thorough assessment must be performed.” A thorough assessment will adopt a multi-method clinical approach (Nay, 1979).
The third fundamental element involves the deployment of an intervention strategy that offers a continuum of care. Such care can range from outpatient individual and group counseling for adolescents at stage one of the disease, to temporary hospital hospitalization for teenagers who have become physiologically addicted (Ross, 1994).
The fourth fundamental element involves a healthy treatment environment (King, 1988; Nay & Ross, 1993; Stanton 1979; Voth, 1980). Treatment climate, staffing patterns, and types of supportive services must be considered.
The fifth fundamental element involves treatment strategies (Ross, 1994). What treatment strategies will be employed in treating the chemically dependent adolescent and what is the rationale for their usage? For example, should treatment include the usage of antipsychotic and antidepressant medications? What kinds of therapeutic approaches work most effectively? What kinds of therapeutic relationships need to be established? Should therapy be conducted in groups or individually?
The sixth fundamental element entails active family involvement, especially on the part of the parents. Selekman and Todd (1991, pp. 8-9) explain: “Although many traditional drug abuse programs for adolescent substance abusers stress the importance of family therapy as a major component, it is questionable how important this modality is in actual practice•..Outmoded belief systems and problem-maintaining patterns of interaction were left untouched while the adolescent was in the hospital or residential treatment program…Considering the impact on he families to which adolescents return, it is no surprise to us that close to 56 percent of the adolescent substance abusers who receive inpatient treatment resume chemical use following discharge.” Thus, treatment strategies that help parents overcome co-dependent enabling behaviors are essential (Ross, 1994).
The seventh fundamental element focuses on developing competent clinical staff (George, 1990; Lawson, Ellis, & River, 1984; Ross, 1991, 1994). Counseling attributes and skills needed to treat chemically dependent youth and their families need to be carefully defined and implemented into treatment.
The eighth fundamental element involves establishing a means to measure the effectiveness or efficacy of treatment and determine its overall cost or efficiency. Friedman and Glichman (1986, p.669) report that “very little is known about the actual ‘state of the art’ of the treatment that is being provided for adolescent substance abusers.” Further compounding the problem is the “state of the art” of the methodology available to evaluate treatment outcome. Sobell, Serge, Sobell, Roy, and Stevens (1987, pp. 113) At best, the overall “state of the art” of treatment in the field of adolescent chemical dependency and accompanying methodology for evaluating treatment outcome is at best, emerging (Ross, 1994, pp. 165-173).