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Why the treatment system is failing adolescents

May 16, 2014
by Shannon Brys, Associate Editor
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While field professionals have long lamented the gaps in the treatment of addictions and mental illness, there is particular urgency on this when discussing adolescent care. More than 90% of adults who have a substance use disorder (SUD) began using as a teenager, says Kathleen Meyers, PhD, a senior scientist at the Treatment Research Institute (TRI).

Because of the high risk of long-term effects associated with teenage substance use, the field has to improve on identifying individuals who are at risk, providing additional types of programming, and allowing increased access through wellness benefits and insurance plans, Meyers says. These resources and treatment should be available to those with low-level use as well, she says.

By comparison, for someone who is at risk for a heart attack, the plan wouldn’t be for the individual to remain at home until the heart attack occurs and then to receive treatment for a few days and be released without any follow-up. Rather, the plan is typically for preventive interventions such as lowering the person’s cholesterol implementing an exercise regimen to assist in weight loss. In the case an event does happen, the person is provided the best care and is closely monitored afterwards to make sure he stays on course.

“We treat adolescent substance use as a discrete one-time condition,” Meyers explains. “We ignore risk factors and continuing care needs. If we’re thinking about substance use as a disease, we’ve got to look at it in the way that you would look at other conditions.”

Time for change

TRI recently released a report titled Paving the Way to Change: Advancing Quality Interventions for Adolescents Who Use, Abuse or Who are Dependent Upon Alcohol or Other Drugs. The report, for which Meyers was lead author, provides insight into the individual, societal and financial consequences of adolescent substance use disorders. It also shines light on the current treatment system and explains “why it is failing our kids.”

A necessary addition, Meyers says, is holistic care. Currently, providers are doing the best they can with limited resources. However, because of the complexities associated with the youth population, holistic care is necessary to assist children with problems in multiple areas of their lives including family, mental health and school.

“The literature is pretty clear that outcome is highly contingent on these other areas that kids bring to the program,” Meyers explains. “So, just addressing substance use does not always – and it rarely does – lead to long-term positive outcomes.”

In addition to expanding adolescent treatment to include all aspects of holistic care, quality needs to be improved by figuring out how to achieve more funding for programs, hiring higher-level staff and linking clients with continuing care after leaving treatment, Meyers says. The report suggests the following components of staff qualifications and training for quality adolescent drug treatment:

  • Clinical staff has training in adolescent development.
  • At least one clinical supervisor possesses a minimum of a master’s degree in a relevant field.
  • The program provides direct service staff with ongoing supervision feedback and evaluation regarding their clinical skills.
  • The program trains counselors in case management, or at least has one designated case manager.
  • The program provides ongoing in-service training, and reimbursement or paid leave for direct service staff and supervisors to obtain training.

Continuing care doesn’t necessarily mean treatment, she says. It could involve gym memberships or other ways of getting adolescents involved in positive activities instead of going back to their habits of using.

After leaving a 25-day residential program or completing four weeks of outpatient care, the adolescent is typically released back into the lifestyle he came from. There is very little step-down care and the individuals do not necessarily have the skill set that will propel them in the long-term, says Meyers. Although they do see some short-term bursts of improvement, adolescents typically last anywhere between three weeks to six months before relapsing, and the vast majority relapse within the first three to six months after leaving treatment, she explains.

One of the main takeaways from the research was that “people don’t recognize that adolescence is the at-risk period for developing a substance use disorder,” says Meyers. Society needs to change the perception that low-level drug use is “not a big deal” because it indeed can lead to serious consequences.

In addition to laying out the issues, the report also provides suggestions for those looking to take action. Individuals and groups – whether it’s researchers, practitioners, family members, or advocates – can come together to determine which pieces each will tackle. Of course, a large part of the issue will be funding. The report makes suggestions regarding funding, including:

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In Sept 2013, I along with another licensed clinician founded (CEASE)Center to End Adolescent Substance Abuse Encounters, Inc., a nonprofit organization with a mission to prevent adolescent substance abuse targeting early adolescents, ages 11-15. We did not need statistical research to convince us that what we were seeing daily for nearly 30 yrs confirmed that well over the majority of our adult substance addicted clients began use in their adolescent years. After moving on to juvenile forensic and her to the school system, we both began to see alarming patterns pertaining to substance use. For me in juvenile forensics, the % of adolescents seen before the courts who had been given prevention messages was almost nonexistent. Efforts to divert or prevent a teen from getting involved in substance use behavior were found to not exist. We of course, are painfully aware that funding for such programming is difficult to come by. Insurance companies do not pay to prevent addiction, but rather, provide limited coverage to treat once an adolescent has developed a substance use disorder.
We spent a considerable amount of time researching the availability of adolescent prevention program in our area, only to come up with nothing that actually go into the community to identify adolescent at-risk for substance abuse and then provided prevention programming.
As such Center to End Adolescent Substance Abuse Encounters, Inc. CEASE was founded. CEASE is being received well and for that we are appreciated. The work is not easy and requires funding which will be our challenge. We invite you to make a difference with us, visit our website at www.ceaseinc.org, sign up to get-to-date blog posts, share with your clients, neighbors, community and join the cause. And please support our mission to provide prevention programming to early adolescents...Donate!!!

Not unlike adults who seek substances, youth who drug seek usually have underlying issues that they are trying to escape the effects of.
Without recognizing this and establishing a level of trust with these kids who are , if not 'system kids', usually not easy to reach, they will continue to repress the pain and the damage will be done.
Youth need support and on-going encouragement from relationships with people they are going to be able to count on. This alone is rare.
They are also going to be reluctant to share with people they feel do not understand where they are coming from and this is where 'peer professionals', or people with first-hand knowledge of what they are experiencing can contribute and give back to their community.
Helping them understand there are people out there who know how they feel while encouraging them to express their feelings artistically in a safe environment can be excellent ways to steer them off the path of drug use and toward healing.

Julia, thanks for these excellent points about adolescent treatment. It seems clear that building this trust is essential when working with the youth population. If you haven't already, I urge you and the other readers to look at Johnny Patout's excellent and engaging article called Ten Essential Tips for Working with Teens; it is posted on this site and is featured as our main cover story in the May/June print issue.

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