Selecting the correct course of action
What kind of treatment is most appropriate for the individual's problem?

Following an assessment of the problem, there are many different treatment options. It is often difficult for parents to assess whether or not professionals need to be involved with their child. Many factors will weigh into the decision making process. If parents themselves have experienced treatment or some kind of mental health intervention either as a child or as an adult their experience (positive or negative) will affect the decisions about their children. The question that parents need to consider is, "if your child cuts himself, and the cut begins to bleed, how much blood do you need to see before you decide he needs to be taken to the hospital"? In other words, will some kind of intervention be necessary to begin to heal the wound.

The Options: How to Choose?

Diversity is a positive thing - Parents are frequently concerned that their child may pick up a worse drug habit if exposed to other people involved in these programs. This question is often a sign of denial. They should ask themselves: "Am I denying my teen's drug problem?" Diversity will help the teen see the rest of the world and how treatment helps others to concentrate on the positive elements. The following checklist will help in determining the proper treatment option for teens:

• Is the patient population all adolescents?
• Is the patient population mixed with adults?
• Is there planning available for continuing care after treatment ends?
• Are there 12 - step meetings available or on site?
• Are other community resources discussed or used?
• Is the staff licensed?
• Is family therapy or support used as part of treatment?
• Are other life management skills taught? I.e., nutrition, exercise, hygiene.
• Is meditation, relaxation, stress reduction part of treatment?
• Is abstinence the goal of treatment?

Intervention Program - Intervention programs for teens come in all shapes and sizes. They can be part of human service agencies, schools, medical treatment centers, doctor's offices, psychologists' offices, town or city services. They may vary in intensity from educational sessions to complicated integration with other agencies and therapeutic group and family sessions. Intervention programs generally have the goal of helping individuals recognize that substance abuse is getting in the way of their living a comfortable manageable life. Helping that individual move forward out of their current problem behaviors, by helping them accept the fact that problems exist, helping them recognize that substance abuse has something to do with those problems, and helping them learn to plan a better way to live. Coercion generally plays a large role in these programs. Teens feel forced by family, police, school, court to participate. Generally they do not accept that their behaviors play a role in the issue at hand.

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Out-patient Treatment - Out-patient treatment is an intervention that is performed outside of a residential treatment or hospital setting, although some outpatient services are located on hospital grounds. The service is traditionally offered by an individual licensed by the state to perform mental health and/or substance abuse treatment. It can be performed in a one on one setting (individual modality), in a group treatment modality or by bringing in the family for family therapy. The model of out-patient treatment can be done intensively by bringing the patient and their family in several times per week engaging an integrated model of modalities and clinicians; and in a less intensive treatment with less frequent visits and clinical interventions. For teens, it's advisable to engage out-patient clinicians who specialize in working with teens for the best success. Most adolescent therapists prefer a group modality to individual treatment.

Checklist for choosing an out-patient therapist for
adolescent substance abuse.

• Therapist licensed in mental health/substance abuse
• Therapist with 5+ years experience
• Group modality preferred (teen group)
• Therapist wants to keep parents/family involved
• Teen seems comfortable with therapist
• Confidentiality is maintained - unless safety is at risk then family is brought in with teen.

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Day Treatment or Partial Hospital Treatment - Day Treatment, sometimes referred to as partial hospital programs is a more intensive form of commitment to treatment than out-patient treatment. The patient commits to spending up to 6 hours per day at the facility, attending various forms of therapeutic interventions. Partial hospital programs can sometimes last up to 14 days. The purpose is for the patient to attend an intensive form of treatment without having to sleep in a residential or hospital facility. For teens, it is often difficult to find partial hospital programs exclusively for that age group. Often these programs mix populations so that teens may be in a program with individuals older and more experienced with substance abuse. There is some controversy among professionals as to the value of this type of mixed population in treatment.

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Hospital Treatment (Detox) - The purpose of hospital care for any individual abusing substances is to help them stay medically safe. These programs often referred to as detoxification units are for patients whose use of drugs puts them in physical danger if they stop without medical supervision. These programs are typically of 3 - 5 day duration. For teens, because of their relative short history of substance abuse, they often do not need this type of intensive medical supervision. Detoxification units are never a substitute for rehabilitation.

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Residential Treatment Centers - Beyond hospital treatment there are programs that exist that provide for short and long-term rehabilitation. These programs can last from 1 - 9 months. For teens they are known as residential treatment centers.

Note: Managed care has greatly restricted healthcare insurance companies from paying for this type of treatment. Therefore there are few programs that currently exist, fewer programs for teens, and most that require out of pocket payment. The programs that do exist combine various therapeutic interventions with recreation, proper nutrition, 12-step program participation, as well as teaching responsibility, honesty and open communication.

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Halfway Houses - Halfway house treatment for individuals with substance abuse and addiction problems is often meant as an alternative to returning home after a residential or hospital stay. These are generally structured programs that combine therapeutic intervention, 12 step programs and community living with other individuals in recovery. It is usually recommended for those individuals whose home environment is not able to support an individual's abstinence from alcohol and other drugs. There are very few opportunities for teens to participate in these programs. The houses are generally designed for individuals beyond the age of adolescence.

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Alcoholics Anonymous and other 12 - Step Programs - For teens, sustained abstinence from alcohol and other mind-altering substances is the goal of the various treatment programs previously mentioned. For this reason, 12 - step programs like AA are often used as part of the treatment's program. These self-help programs promote abstinence as a way of improving the manageability of an individuals life. Positive aspects of these programs:

• No fees required
• Meetings available 7 days per week, all different times of day, all over the world.
• Promotes people helping people.
• The most successful form of intervention historically known for substance abusers.

Negative aspects of these programs:

• Teen groups not as available as adult groups.
• Success requires self-motivation - difficult for emotionally troubled teens.
• No professional leadership.

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Behavioral Therapy for Adolescents - This type of treatment focuses on changing negative behavior by demonstrating more accepted behavior in incremental steps. Specific strategies include fulfilling assignments, rehearsing wanted behaviors and recording/reviewing progress. Rewards are given after achieving desired goals. Urine testing is a regular part of this program.

Program goals for patients include

• stimulus control: helping teens avoid drug using situations with alternative activities suggested
• urge control: helping teens recognize thoughts, feelings and plans leading to drug use;
• social control: the inclusion of family members or significant others to reinforce desired behavior.

According to research by the National Institute on Drug Abuse (NIDA), including family members as well as urinalysis increases success for teens in this program. It also helps teens with school/work attendance, family relationships, depression, institutionalization and alcohol abuse.

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Multidimensional Family Therapy for Adolescents (MDFT) - This type of treatment focuses on the network of influences on teens eg. individual, peer, family and community in an outpatient setting. The goal is to focus on how these influences affect teens in different settings. Treatment sessions are held in the clinic, at home, in family court, school or other community locations. Individual sessions help teens with decision making, negotiation, problem solving, communicating their thoughts and feelings appropriately as well as vocational skills.

In order to have positive influences on their teens, parents attend parallel sessions to help them with their parenting style.

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Multisystemic Therapy (MST) - This type of treatment focuses on more severe antisocial behavior in adolescents. If teens and their families demonstrate any of the following, then this type of therapy can be beneficial.

• teens and their families demonstrate favorable attitudes toward drug use
• parents demonstrate poor discipline
• parental drug use
• family conflict
• peers are drug users
• teens have poor attendance or drop out of school
• community fosters criminal activity

Intensive treatment takes place in teens' homes, schools and neighborhood settings. Research has indicated that this type of treatment reduces teen drug use, incarcerations, and out-of-home placements for at least 6 months post treatment.