At age 20, Zack dropped out of college after only one semester. He had failed each of his classes, although he had been an above-average student in high school. When Zack returned home to live with his parents, his mood was unpredictable, and he engaged in bizarre behavior. He became angry easily. He seemed depressed. He often slept all day.
When confronted by his father, Zack admitted to some drug use but offered few details. Zack later informed his father that the house phones had been bugged with a monitoring device and that the family may be in danger.
Zack's parents sought professional help and staged an intervention. With the help of a facilitator, friends, and other family members, Zack's parents confronted their son about his substance abuse, irresponsibility, and recent changes in mood and behavior. The intervention ended with a simple message: “We love you too much to sit back and watch you self-destruct.”
Twelve hours after the intervention, Zack was admitted to an inpatient treatment center with a provisional diagnosis of alcohol abuse and methamphetamine abuse, and to “rule out” substance-induced mood disorder as set out in the DSM-IV, meaning that the question of whether the mood disorder was substance-related would be determined later.
Zack is part of a population whose presence is becoming more common in treatment centers in the United States. Young adults between the ages of 18 and 25 make up approximately 21% of people receiving treatment for substance abuse in hospitals, inpatient and outpatient rehabilitation facilities, and mental health clinics.1
Clients such as Zack present a number of challenges for counselors. Young adults often perceive substance abuse treatment as a punishment imposed by others, not a personal choice. Many young adults generally perceive recovery values as an infringement on independence and an unwanted extension of parental authority. Young adult clients may communicate ambivalence to treatment interventions in ways that frustrate counselors and threaten other adult clients in the group counseling environment.
Since young adult clients usually depend on family members for financial support, the troubled relationships that many have with parents or relatives may generate additional challenges for counselors. Family members often will constitute an integral part of a young adult client's treatment at every stage, from the admissions process to aftercare planning. Family members may present complications to counselors by way of unrealistic expectations of the treatment process, poor boundaries with the client, or personal preferences that they wish to impose upon their child or relative.
Finally, the 12-Step model itself may present difficulties for counselors attempting to address young adult clients' needs. Traditional concepts such as “hitting bottom” need to be modified for younger clients. The usual consequences that older adults use to mea-sure the severity of their substance abuse, such as worsening physical health or the loss of a meaningful career, may not be applicable to clients ages 18 to 25. In fact, the concept of “recovery” itself may need to be modified, in that many young adult clients will not have established a measurement of health or success in life that they desire to regain or recover.
By informing counselors about current research pertaining to young adults' developmental needs, this article intends to help counselors intervene effectively on some of the more predictable problems presented by clients ages 18 to 25 with substance abuse problems.
Ambivalence and motivation for change
Professionals must present the recovery process as a method for young adults to achieve the goals they most often expect from themselves.2 At this juncture, an updated understanding of developmental needs for individuals between the ages of 18 and 25 is essential to treatment planning and problem solving.
A recent study shows that many young adults do not deeply value the traditional notions of adulthood as much as they do the notion of self-sufficiency.3 Completing an education, establishing a career, getting married, and starting a family are often ranked lower by young adults than are the desires to make decisions independently and to achieve financial independence.
Counselors can assist young adult clients in learning how to recognize substance abuse and other behavioral health disorders as barriers that, when not properly treated, prevent true self-sufficiency. This stance alone may improve counselors' likelihood of achieving a therapeutic alliance with young adult clients.
Even in alliance with counselors, however, young adults often will experience ambivalence toward the treatment process. Ambivalence, and the manner in which it is expressed, is most effectively intervened on within the context of a “readiness to change” model.4 Within such a model, a client's readiness to change may be rated on a continuum of possibilities ranging from “not ready to change” to “actively trying to change.” If young adult clients are not able to recognize behaviors such as substance abuse as undesirable and in need of change, counselors must create treatment plans based on the concept of discovery instead of recovery.