substance use and helping patients attain abstinence during treatment sessions, rather than ongoing lifestyle changes. Therapeutic communities help residents evaluate their personal behaviors and learn to engage in healthy lifestyles (National Institute on Drug Abuse, 2015). Successful participation in the life of a therapeutic community includes being honest, taking personal
responsibility, working hard, and being willing to learn. As residents move through stages of recovery, they undertake greater personal and social responsibilities in the therapeutic community. The overall goal is for the therapeutic community resident to leave the program substance-free as well as employed, in school, or in training (National Institute on Drug Abuse, 2015).
TREATMENT APPROACHES
Treatment plans for adolescents with substance use disorders must consider their age, ethnicity, gender, gender orientation, sexual orientation, and cultural background. Healthcare professionals must understand that adolescents with substance use disorders commonly have additional comorbid mental and physical disorders. Moreover, legal problems, homelessness, and sexual orientation confusion are commonly seen in this population. Adolescents with these additional difficulties typically do not respond well to traditional counseling/treatment programs and may benefit Abstinence vs. Harm Reduction There are generally two main approaches to SUD treatment: Abstinence and harm reduction. It is important that healthcare professionals become familiar with each The most traditional SUD treatment form is abstinence. With abstinence, affected adolescents must abstain entirely from drugs and alcohol. Proponents of abstinence believe that persons with SUD cannot moderate their substance use without having negative outcomes (Pyramid Healthcare, 2020). philosophy. Abstinence Substance use impairs judgment and the decision-making process. If people continue to use substances during treatment, even if use is decreased, there is a significant risk of relapsing. There is also a risk of developing an addiction to another substance if abstinence is not practiced (Pyramid Healthcare, 2020). Motivational Interviewing Adolescents benefit from having healthcare professionals who listen carefully; accept where they are in their change process; and help them move toward their own goals with support, resources, and direction. A successful approach for working with adolescents is motivational interviewing (MI). MI is a treatment approach developed to help people find the motivation to make a positive behavioral change. Four critical aspects of motivational interviewing include having the interviewer (American Academy of Family Physicians, 2019): ● Ask open-ended questions as opposed to yes/no questions. ● Provide affirmations and support. Be happy for patients’ successes and be supportive during challenging circumstances. ● Implement reflective listening. This technique helps patients to express themselves and facilitate ideas for change. ● Summarize therapeutic sessions. This summary should include a review of what the patient has discussed and allows the patient to correct any misconceptions. At the conclusion of the summary, patients should be asked what they think the next step in the therapeutic process should be.
from care through specialized agencies (Guerrero et al., 2015). Although an adolescent’s willing agreement to abstain from substance use is ideal as a treatment goal, such an agreement is often not forthcoming. Many adolescents are unable to understand that the consequences warrant giving up drugs and/or alcohol along with the friends, associations, and situations that go along with the lifestyle. Others, regardless of the consequences, are simply not ready for abstinence. Harm Reduction Model The harm reduction model focuses on decreasing the negative outcomes of SUD over complete abstinence, noting that abstinence may not work for all people. The harm reduction model’s overall goals are to reduce (Pyramid Healthcare, 2020): ● The risk of fatalities ● The incidence of medical complications ● Financial consequences ● Legal consequences ● Interpersonal relationship strain After the establishment of a trusting therapeutic alliance, therapists help patients to focus on problematic issues in their lives. As therapeutic relationships progress, patients are eventually encouraged to address and face their substance use (Pyramid Healthcare, 2020). Some people with SUD are not willing and/or able to completely stop using drugs and/or alcohol. They may be willing to practice moderation. In cases such as these, harm reduction may be the most appropriate treatment strategy (Pyramid Healthcare, 2020). MI is typically based on the stages of change model. Adolescents who enter SUD treatment (especially those who do not enter treatment voluntarily) may not acknowledge that their behavior is something that needs to change. They may not believe that their substance use is problematic. Instead, they think that they can control their substance use and continue to enjoy using their substance(s) of choice (American Addiction Center, 2020). The first thing the healthcare professional must do is to determine where the patients stand on willingness to accept the need to change their behaviors. The goal is for adolescents to move through the stages of change as part of the motivational therapeutic relationship. The stages of change are (American Addiction Center, 2020): ● Stage 1 is the precontemplation stage. In this stage the adolescent sees little or no need to change behavior, even if they are dealing with some negative consequences of such behavior. There is little or no motivation to change, since the adolescent does not think they have a substance use problem. ● Stage 2 is the contemplation stage. During this stage the adolescent may recognize that their behavior is problematic, but they are ambivalent about changing.
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Book Code: SWUS1525
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