TAFS AUSTIN

Helping a teenager overcome a drug or alcohol problem is one of the most critical trials any parent can face. In the chaos of addiction, there are many questions: How do I find the right care for my child? Should I send my teen away to recover, or seek help closer to home? How do I tell a good program from a bad one?

One of the smartest things parents can do, experts say, is to get educated aboutscience-based recovery programs for teen substance abuse.

You can learn the principles of effective treatment – written by independent, national addiction medicine experts.

Weʼve incorporated many of their insights into our tips for teen treatment:

PARENT PRIMER: GUIDELINES FOR TEEN RECOVERY

1. Get an independent assessment.

Does your teen have a physical dependence on drugs or alcohol? Or is the risky behavior driven by peer pressure, an underlying conduct disorder or family conflict? Some teens may be using drugs to blunt the pain of bullying or untreated depression. A thorough clinical assessment is a crucial first step to find the right care for your child.

Even if your teen is not addicted to drugs, there are often benefits to treatment. Substance abuse poses a real health danger, and can interfere with cognitive development and key adolescent milestones, according to the National Institute on Drug Abuse (NIDA). Your teenʼs assessment should be performed by a licensed mental health professional or substance abuse counselor who is not affiliated with a drug rehab facility or residential program. Ideally, an Addiction Psychiatrist or independent professional certified by the American Society of Addiction Medicine (ASAM) should conduct the assessment. Ask your family physician for a referral, or try these resources:

The Child and Adolescent Psychiatrist Finder:(a service of the American Academy of Child & Adolescent Psychiatry):http://www.aacap.org/AACAP/Families_and_Youth/Resources/CAP_Finder.aspx

American Society of Addiction Medicine, Physician Member Search:http://community.asam.org/search/default.asp?m=basic

If these experts are not available in your area, look for a licensed mental health counselor with a masterʼs degree and experience with teen addiction.

The assessment should evaluate the severity of your teenʼs problem, including signs of abuse and dependence – as well as your childʼs strengths, mental and physical health, juvenile justice involvement, peer relations, school functioning and other issues. This will determine the level of intervention and resources needed for your childʼs recovery.

2. Find teen-centric treatment.

“You cannot force an adult treatment model onto a teenager. There are too many differences,” says Ken Winters, Director of the Center for Adolescent Substance Abuse Research and a Professor in the Department of Psychiatry at the University of Minnesota. Winters is a consultant for the National Institute on Drug Abuse and helped author treatment guidelines for the Partnership for Drug-Free Kids, which notes: “Adolescent treatment is more focused on acting out behaviors, family dynamics, education, appropriately separating oneself from his or family, and peer issues. For day programs, inhouse schooling is provided. Adolescent programs routinely use group therapy since teenagers are peer-focused, and respond well to group dynamics.”Call adolescent programs in your area to find out the age cut-off (some programs accept young adults up to age 25). You can also contact the national Referral Helpline at 1-800-662-HELP, operated by the Substance Abuse and Mental Health Services Administration (SAMHSA), or get independent treatment referrals by callingdrugrehab.org, 888-957-3422.

3. Choose evidence-based practices.

Neuroscience has advanced our understanding of addiction as a chronic but treatable brain disease. Approaches to treatment that are research-proven or “evidence-based” will increase the odds of long-term recovery. Be skeptical of claims for treatment success rates that are not validated by independent research, and ask questions about therapeutic approaches that may be used with your child.

Examples of evidence-based practices include Cognitive Behavioral Therapy (CBT), which is well-proven to help people in recovery change their thinking patterns, cope with drug cravings and prevent relapse. Contingency Management and Motivational Interviewing are other evidence-based approaches. These can decrease a teenʼs ambivalence about drugs, using incentives to quit smoking or stop drug and alcohol use.

Behavioral interventions that have been shown to be effective include the Community Reinforcement Approach (A-CRA), which helps teens replace bad influences with healthier social, family, job, and educational reinforcers. Evidence-based care may also include a variety of family therapy interventions and 12-step facilitation therapy (Alcoholics Anonymous, Narcotics Anonymous) to extend treatment gains andsupport long-term recovery. 

Medication therapies are also backed by research and can help ease physical withdrawal symptoms and reduce cravings for adults in recovery (naltrexone and buprenorphine are two examples). However, there is little research on the use of these therapies for teens; some practitioners use them for older, drug-addicted adolescents.

4. Beware of boot camps and “tough love” programs 

A punitive program for troubled teenagers can harm your child, experts say, and is not regulated by federal authorities or endorsed by addiction medicine professionals. The opposite approach – reward-based incentive programs – has been shown to be effective for teens with substance use problems.

Hereʼs what the Partnership for Drug-Free Kids has to say about punitive programs:

“It is important to know that boot camps and wilderness programs are not one of the levels of care defined by the American Society of Addiction Medicine. Although you may have heard success stories or read about how great boot camps are, we strongly suggest you look very carefully into any boot camp or wilderness program before sending your teen for substance abuse treatment.

According to a government report (http://www.gao.gov/new.items/d08146t.pdf) these programs are not subjected to federal oversight and there have been thousands of reports of neglect and abuse at privately owned and operated boot camps and wilderness programs for troubled youth.”

5. Look for care that addresses the whole person.

Many teenagers who use drugs and alcohol have co-occurring mental or behavioral health issues (such as depression, bipolar disorder, ADHD, etc.). The best treatment will address any “dual diagnosis” issues and provide an individualized recovery plan for your childʼs unique mental and physical needs. 

“Programs should either have staff with specific mental health training, or have a partnership with clinicians who can provide these services,” says George Youngblood, CEO of Teen and Family Services, a Texas-based nonprofit recovery program for adolescents.

Individual and group counseling may be modified based on the clientʼs cognitive deficits, vulnerabilities or level of social support needed. A successful program delivers interventions at different stages of recovery and has a solid relapse prevention plan — since higher rates of relapse are associated with dual diagnosis.

To learn more about the complex needs of people with addiction and mental healthissues, click here:http://www.drugabuse.gov/publications/comorbidity-addiction-other-mental-illnesses/why-dodrug-use-disorders-often-co-occur-other-mental-illnesses

6. Know the standards for experienced staff.

A quality treatment program should include licensed drug and alcohol counselors with proven mastery in helping teens conquer addiction. At a minimum, counselors should hold state licensure and certification in their field of practice (education requirements vary widely by state for licensure/certification). They should also pass criminal background checks and child abuse registry checks.

Ideally, counselors will have advanced degrees in their field, with credentials from the National Certification Commission for Addiction Professionals (NCC AP). There are three levels of NCC AP certification – based on formal training, knowledge and skills.

Ask how often your teen will meet with a counselor, and know the staff-to-client ratio. Effective care is multi-disciplinary and integrated; in residential settings, that includes a full-time Medical Director certified in addiction medicine or addiction psychiatry; fulltime nursing staff; and qualified substance abuse counselors, case managers and certified nutritionists.

7. Residential care is not the only option.

Before you explore a residential program, collaborate with the physician or independent mental health professional who conducts your teenʼs assessment. Ask whether a local, less-restrictive program would be a good fit for your childʼs situation.The Building Bridges Initiative (BBI), endorsed by several national mental health groups, says residential programs are best used sparingly “to achieve a specific goal like respite, assessment, medication stabilization, or learning particular skills in preparation for return to the community.”

Ask about intensive services in your community, or home-based support for teen recovery. If your child does require residential care, seek the quality indicators detailed in this article. The facility should also be state-licensed and accredited by the Joint Commission, the Council on Accreditation or the Commission on Accreditation of Rehabilitation Facilities.

8. Find help near home.

Itʼs best to establish treatment close to home, since a good teen program includes regular family involvement, says Winters, the Director of the Center for Adolescent Substance Abuse Research.

To locate services in your area, ask your childʼs physician, school nurse, church or othercommunity resource such as a juvenile social worker.

You can also use the national Substance Abuse Treatment Facility Locator, provided bythe Substance Abuse and Mental Health Services Administration (SAMHSA):https://findtreatment.samhsa.gov/TreatmentLocator/faces/quickSearch.jspx. Or call SAMHSAʼs Referral Helpline at 1-800-662-HELP (English & Español). Another hotline offering free, independent referrals 24/7 is operated by drugrehab.org, 888-957-3422.

If your community has limited resources, ask for help coordinating the care your child needs – for example, referrals to mental health counselors, peer mentors, self-help groups, sober college dormitories, etc. And if the only treatment option is residential care out-of-state, ask how the family can be actively involved in your teenʼs  recovery.

9. Select treatment that engages the family.

“Family involvement is really the key to success,” says Youngblood. “Ideally, parents participate in weekly family counseling, multi-family groups and attend their own recovery support groups.”

Research shows that having a strong support network improves the chances of longterm recovery. Family members can motivate the teen to complete treatment, help schedule therapy appointments, and provide ongoing support for healthy living habits and relapse prevention.

Youngblood says parents should expect a clearly defined treatment plan with goals andobjectives, and a discharge plan that supports recovery.

“They (parents) should expect the program staff to communicate progress in clear to understandable terms,” he says. “I would be very suspicious of any program that requires signing away parental rights.”

“Also, parents should do their homework. Search the web for any information from former clients of the program. It is OK to ask the staff hard questions, and keep in mind you are still the parent, you have the right to ask that your child not participate in any aspect of a program.”

10. Continue treatment gains with a strong “after care” program.

Drug and alcohol addiction requires continual maintenance to prevent relapse and sustain recovery. Your teen’s program should include a quality after care program as part of the treatment continuum.

After care services can include special high schools with a state-approved curriculum for teenagers in recovery, and sober living dorms on college campuses. Other post-treatment services may include private therapists, teen and parent support groups, 12-step fellowship programs, and peer mentors who can provide coaching and connect teens to sober social networks.“To be considered in full remission, those individuals diagnosed with addiction need to have established five years without negative consequences related to substance abuse,” Youngblood says. “This means that treatment/recovery services should be available on a continuum that spans this length of time.”

TREATMENT GUIDES

These free publications from national addiction experts can help you choose effectivetreatment and guide your teenager toward a healthy, drug-free life:

PRINCIPLES OF ADOLESCENT SUBSTANCE USE DISORDER TREATMENT: ARESEARCH-BASED GUIDE

https://www.drugabuse.gov/sites/default/files/podata_1_17_14.pdf

In-depth primer on the principles for effective drug and alcohol treatment for teenagers. From the National Institute on Drug Abuse (NIDA).

TREATMENT eBOOK:How to find the right help for your child with an alcohol or drug problem

http://www.drugfree.org/wp-content/uploads/2012/04/treatment_guide-2014.pdf

A parent handbook on appropriate addiction care for teenagers, from the Partnership for Drug-Free Kids. Includes how to pay for treatment, the importance of family therapy and other topics.

TIP SHEET FOR FAMILIES CONSIDERING A RESIDENTIAL PROGRAM

http://www.buildingbridges4youth.org/sites/default/files/BB-Family-Tip-Sheetexpanded.pdf

Addresses questions about residential treatment for a child with emotional and behavioral challenges. Published by Building Bridges, a national family support initiative.

WARNING SIGNS: CAUTIONS WHEN CONSIDERING A RESIDENTIAL PLACEMENT FOR A CHILD OR ADOLESCENT http://www.astartforteens.org/warning-signs Recommendations for finding a safe residential program, from The Alliance for the Safe, Therapeutic and Appropriate use of Residential Treatment (ASTART)

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