● Stage 4 is the action stage. During this stage, the adolescent has developed some strengths that allow for behavioral change. A plan is developed for making changes and how this is going to be accomplished. An overall rule is that adolescents must have made changes that have been in place for a minimum of 6 months in order to qualify for this stage. ● Stage 5 is the maintenance stage. During this stage, the adolescent may still be working on change but is competent enough to have changed their behaviors. The adolescent continues to make changes and deal with any barriers that are encountered. As an overall rule, participants must have made changes that have been in place for a minimum of 6 months to qualify for the maintenance stage. ● Stage 6 is the termination stage. In this stage, the adolescent has successfully made all of the changes necessary to face new challenges and continue to live productively. Many people in treatment for SUD continue to participate in social support efforts such as 12-step groups for years after they have become sober or abstinent. Participation in such groups helps to maintain abstinence and/or sobriety and continues to improve their life circumstances. Healthcare Professional Consideration: Some of the literature also refers to a relapse stage. This is characterized by a resumption of problematic behavior and the need for help to return to recovery. Note that not all people go through a relapse stage Evidence-Based Practice Multiple research studies indicate that CBT leads to significant improvement in ability to function and in quality of life. Research supports CBT as a means of therapy that produces change (American Psychological Society, 2017). CBT is based on several central core principles, including the following (American Psychological Society, 2017). ● Psychological problems are partially because of faulty or unhelpful ways of thinking. ● Psychological problems are partially because of learned patterns of unhelpful behavior. ● People who are dealing with psychological issues can learn better ways of coping with problems, which can lead to a reduction or elimination of symptoms and an increase in life satisfaction. CBT therapists may use various techniques to help adolescents change their substance use and/or dependent behaviors. experiments” in which adolescents are encouraged to try out new responses to triggers and other situations discussed in therapy sessions. However, it is important to recognize that adolescents who have not been successful in academic settings may resist homework. In these cases, extending the therapeutic time to include such reinforcing work may be the best plan (Kendall & Peterman, 2015). drugs, and the healthcare professional guides them through the step-by-step process of facing and successfully dealing with the situation. The adolescents then work on practicing or rehearsing these steps mentally. Ideally, when the situation arises in real life, the adolescents can address it by drawing upon the rehearsed way of thinking and behaving (Clark, 2019; Kendall & Peterman, 2015).
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. Even if they want to change, they have not yet put any effort into making changes. ● Stage 3 is the preparation stage. During this stage the adolescent makes a commitment to change their behaviors and accept responsibility for accomplishing this change. Some adolescents may have tried to develop a plan for change but have not yet taken any formal action. Cognitive-Behavioral Therapy Cognitive-behavioral therapy (CBT) is based on the tenet that there is an interaction among an individual’s thoughts, feelings, and behaviors and that this relationship can be adjusted for insights, awareness, and behavioral change. To achieve reduced risk behaviors and/or abstinence from substances, CBT involves the primary strategies of changing maladaptive coping skills, self-monitoring, setting goals, and using adaptive decision making (Wilkens & Kosanke, 2015). In cases of SUD, CBT is a focused therapy to help patients recognize the situations in which they are most likely to use substances, avoid these types of situations, and deal with problems and behaviors linked to substance use more effectively (Rebar et al., 2020). Behavioral Homework Assignments Proponents of behavioral homework assignments believe that without them, the insights and plans that emerged during therapy sessions may be inhibited by patterns of negative thinking and behavior outside of the therapeutic environment (Minden, 2017). CBT therapists frequently request that their adolescent patients complete homework assignments between counseling sessions. These assignments may consist of real-life “behavioral Cognitive Rehearsal Cognitive rehearsal is an evidence-based CBT technique. The premise of cognitive rehearsal is that patients practice encountering a difficult situation (e.g., being offered drugs) and dealing with it effectively. Practice occurs in a nonthreatening environment with a facilitator who is well versed in cognitive rehearsal (Clark, 2019). Cognitive rehearsal may be conducted in a group setting as well as individually with the therapist. During cognitive rehearsal, adolescents imagine a difficult situation such as being offered
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