Treatment

Human service workers need an understanding of the stages of substance abuse, the areas of life that are affected by abuse, and how to assess when it becomes a problem. There are a number of screening tools available to assess an individual’s involvement with alcohol and drugs.

Programs must consider the individuality and co-occurring or co-existing mental health needs of youth with substance disorders. There is little evidence that one modality of treatment or session format (i.e., individual, group, or family) is appropriate for all clients. Flexibility, availability, and treatment matching a client’s needs to available services are the most effective approach. Evidence-based practices for youth include protocols that are motivational, cognitive-behavioral and behavioral, family-oriented, and centered around 12-step strategies.  

Programs should make the orientation process inviting and easy to understand. Materials that explain the process of treatment (i.e., the consent for treatment, confidentiality, available options) should also be available to family members so they have a clear understanding of what is to be expected of the youth and their families and the clinicians. This vital component of service is often brushed over, but it is essential to engaging families.

Services must be engaging (i.e., dynamic and active, and focused on the individual), clinically and developmentally appropriate, and strengths-based. Evidence-based treatment manuals address developmental factors, including adapting to situations, triggers, and consequences for youth. These manuals offer treatments that use motivational philosophies to engage individuals in treatment, use concrete versus abstract concepts, deal with loss-of-control issues, support recovery environments, and support continued care. These adolescent practices include targeted sessions for victimization/trauma, anger management, depression, and gender and cultural issues.

Treatment should emphasize the acquisition of new abilities and skills to deal with the issues. Programs should also include ongoing psychiatric services with continued assessment, medication management, and family involvement (i.e., assessment, parent education, multifamily groups, family counseling, parent behavior training, and home visits). Of equal importance is linkage to education services (on-site if residential), wrap-around services (e.g., care coordination of formal services and interventions, together with community services and interpersonal support and assistance provided by friends, relatives, and other people drawn from the family’s social networks), health care services (e.g., contraception, testing for sexually transmitted diseases, and treatment for asthma/respiratory problems), recreational activities (e.g., room for gross motor activities), and exposure to non-using activities.

A continuum of care must respond to the full range of service needs: prevention, screening, assessment, intervention, a menu of treatment options, case management/specialized rehabilitation, and continued care.

Gender competence and cultural competence are essential in developing a successful therapeutic alliance between a youth and his or her counselor. Programs must take into account the significant differences between male and female adolescent substance users. The same type of program responsiveness is critical for working with youth and families of mixed racial and cultural identities. Sensitivity to others and factors that help build trust are especially important for gay and lesbian youth who might not otherwise be willing or able to address key aspects of their identity.