● Not steal or destroy the property of another resident ● Adhere to a curfew Therapeutic Communities Residential treatment for those with SUD originated in the late 1950s. It grew out of the self-help recovery movement that included groups such as Alcoholics Anonymous (AA; National Institute on Drug Abuse, 2015). An alternative to out- or inpatient hospital treatment is longer-term residential treatment, such as therapeutic communities. These are highly structured residential facilities that use peer influence with substance abusing or dependent residents to change behaviors. Residents are encouraged to form strong emotional ties with staff and other clients. It is considered healing and therapeutic for adolescents to consider themselves as part of a mutually supportive, cooperative group (Stahler et al., 2016). Therapeutic communities are most appropriate for persons with severe substance use and behavior problems. These communities were originally developed for adults and later adapted to treat adolescents. A holistic treatment approach is implemented that includes habilitation, in which residents adopt lifestyles that are socially compatible, and rehabilitation, through which adolescents can return to a previous ability for healthy functioning (Stahler et al., 2016).
● Attend designated recovery meetings
Therapeutic communities have a recovery orientation that focuses on the whole person and lifestyle changes, not only on abstinence from substance use. Recovery is seen as a gradual, ongoing process that facilitates cognitive change. An acute care orientation model focuses on inhibiting 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 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 philosophy. Abstinence 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). 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). Harm Reduction Model 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.
programs and may benefit 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. 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). ● 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. 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.
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Book Code: SWUS1524B
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