Recent literature suggests that the level of alcohol and other drug dependence in the adolescent population requires the presence of treatment services tailored to youths' unique needs.1 The federally supported Drug Abuse Treatment Outcome Studies for Adolescents (DATOS-A) suggested that positive outcomes are possible when treatment reflects the adolescent's cultural views.2 Hser and colleagues report that an improvement in treatment retention and completion are needed to maximize the benefits of adolescent drug treatment.3
With these findings as a premise, I have taken an uncommon approach in working with adolescents who abuse substances or are substance-dependent. Starting with William Glas-ser's concept of Reality Therapy,4 I ask many of the standard demographic questions during the intake session, but then I ask the adolescent how he/she sees the need for belonging, power, freedom, survival, and fun being met in his/her life today.
In many cases, the client has been referred to treatment by the justice system, the school system, or parents or other adult authority figures. According to many of my clients, these individuals or entities have made them feel less than affirmed as reasonable, intelligent human beings. Framing my “needs” questions allows the client to be heard and appreciated in a manner he/she does not usually expect from an adult.
The next level of discussion centers on the adolescent client's “need” for fun. Asking “When was the last time you had fun? What did you do?” brings an interesting array of answers. These answers can lead to a deeper understanding of some of the reasons the adolescent is using substances.
Helping the youth gain control
These questions help touch on the concept of balance in the client's life. The client's attempt to satisfy needs in a certain way often leads to impulsive behavior. Working with the client to begin to satisfy these needs in a manner not harmful to self or others allows him/her to get a glimpse of a life back in control.
For example, in addressing the need for freedom, the client might be encouraged to seek opinions from knowledgeable and trustworthy people and then to make a decision, rather than using the concept of independence as a justification for cutting himself off from all sources of information.
The following three questions become the standard opening for all subsequent sessions with the adolescent client, as well as the questions the client should ask himself each day:
“On a scale of one to ten, how are you doing right now? One is the worst day and ten is the best day.” This allows the client to verbalize current feelings and thoughts.
“What is your plan for today?” This constitutes an attempt to fight off impulsive thoughts and behaviors from the past.
“When was the last time you had fun, and what did you do? When is the next time you plan to have fun?” These questions allow the client to self-assess once again, offering some sense of hope in the future that is worth working toward. This same style of question can be asked about the needs of survival, belonging, power, and freedom.
This approach catches the attention of many of my clients as unique. And by the way, Mr./Ms. Therapist, when was the last time you had fun?
Steven Durkee, LPCC, CADC, is President of the Kentucky Association of Addiction Professionals and a member of the Adolescent Specialty Committee of NAADAC, The Association for Addiction Professionals.
- Vourakis C. Admission variables as predictors of completion in an adolescent residential drug treatment program. J Child Adol Psych Nursing 2005; 18:161.
- Etheridge R, Smith I, Rounds-Bryant J, et al. Drug abuse treatment and comprehensive services for adolescents. J Adol Research 2001; 16:563-89.
- Hser Y, Grella C, Hsieh S, et al. An evaluation of drug treatments for adolescents in four U.S. cities. Arch Gen Psychiatry 2001; 58:689-95.
- Glasser W. Reality Therapy. New York:: HarperCollins; 1965.