AdolescentsClinical Practice with Addictive Disorders

Renee Hillsman Tamara Robinson Tracy Tarbutton Tammy Wilbanks

Renee Hillsman Tamara Robinson Tracy Tarbutton Tammy Wilbanks

Treatment Considerations

Family

IndividualDevelopmental

Stages

School

Stages ofChange

Demographics

Peer

Community

View From Within The Whirlwind

“With adolescence, many kinds of development occur -

physical, emotional, intellectual, academic, social and spiritual-and they don’t always occur in tandem.”

Pipher, M. (1994). Reviving Ophelia: saving the selves of adolescent girls. New York, NY: Ballantine Books.

“Family is the essential presence-the thing that never leaves you even if you have to leave it”

Buford, Bill (1955). The Family. New York: Granta Books

Detached - “mall orphans”Parental substance useLow affection/stabilityNo Parental Monitoring

“ Schools are better at pulling weeds than at planting flowers”

Eisner, E. (1990). Who Decides What Schools Teach? Phi Delta Kappan 71: 523-526.

Islands of stability or arenas for battle?Negative school climateTraumatic experiencesRejection/isolation/exclusion/alienation

“Every citizen shares the responsibility of

creating communities in whichall youth can thrive and grow.”

Seita, J.R. & Brendtro, L.K. (2005). Kids who outwit adults.

Complacent/permissive normsDrug availabilityLack of neighborhood attachmentLow socioeconomic status

“And why does he hang out with his friends? Because any one of these kids would take a bat to your head if he asked them to.

It’s called loyalty” Sean, Maguire, Will Hunting’s therapist, Good Will

Hunting

Peer influence: a powerful social needYouth increase freedom from adult

authority

Rules of Engagement

The Distrust Lens

“Do unto others” vs. “tit for tat”

Private Logic

I am…. Other people are… The world is…. Therefore I am….

Flight/Fight/Fool

“Teenagers often perceive the acts of volunteering

information about themselves and

communicating approval for a therapist as large

concessions of power, and such concessions are

dispensed sparingly by teenagers who feel a need

to exert control over the session”

“I want them (parents, teachers, therapists,

everybody) to know how angry/unhappy/frightened/confused I am. And if I

stop yelling/cutting/running away/drinking/pouting,

they’ll think everything’s fine”

“Adolescents need help from

therapists in FINDING EXIT STRATEGIES from their

problems that keep intact their sense of dignity”

Questions Teenagers Hate

“How does that make you feel?”

“Do you think that’s such a good idea?”

“Why do you think you did that?”

How We End Up NOT Helping

Thinking that CREDIBILITY = LIKEABILITY or TRUSTWORTHINESS

Soliciting the adolescent’s APPROVALPresenting oneself as too helpfulBeing too careful: THINK CANDOR

AND CONNECTIONTrying to mask the fact that you’re

stumpedTrying to exert control over the

therapeutic process

Continuum of Use

AbuserAbuser

PreventionInterventionTreatment

RegularUser

RegularUser

RecreationUser

RecreationUser

SubstanceDependent

SubstanceDependent

Non-UserNon-User

ExperimentalUser

ExperimentalUser

Adolescent Substance Use

¼ of youth age10-17 say theirfriends “huff”

¼ of youth age10-17 say theirfriends “huff”

10.4 million current drinkerof alcohol are age 12 to 20

10.4 million current drinkerof alcohol are age 12 to 20

Youth age 16 to 17 have2nd highest rate of current illicit

drug use

Youth age 16 to 17 have2nd highest rate of current illicit

drug use

Youth age reportedmarijuana as the

mostfrequently used

illicit drug

Youth age reportedmarijuana as the

mostfrequently used

illicit drug

1.1 million of youth age 12-17 are dependent on

illicit drugs

1.1 million of youth age 12-17 are dependent on

illicit drugs

TitleTitleScope

Of Problem

More than half of 12th graders have tried an

illicit drug

More than half of 12th graders have tried an

illicit drug

Signs of Drug Use

Negative changes in schoolwork; missing school or declining grades

Increased secrecy about possessions of activities Use of incense, room deodorant or perfume to hide smoke or

chemical odors Subtle changes in conversation with friends, e.g., more secretive,

using “coded” language New friends Change in clothing choices – new fascination with clothes that

highlight drug use Increase in borrowing money Evidence of inhaling products and accessories, such as hairspray,

nail polish, correction fluid, paper bags, common household products

Bottles of eye drops, which may be used to mask bloodshot eyes or dilated pupils

New use of mouthwash or breath mints to cover up the smell of alcohol

Missing prescription drugs – especially narcotics and mood stabilizers

Lack of interest in personal appearance

Consequences

Traffic Accidents

Physical/MentalConsequences

DevelopmentalProblems

JuvenileCrime

School-RelatedProblems

Risky SexualBehavior

DelinquentBehavior

Future Use Disorder

Adolescent

Substance

Use

Adolescent

Substance

Use

Treatment Setting

PartialHospitalizatio

n

In-patientHospitalizati

on Long-TermResidential

IntensiveOutpatient Outpatient

Insurance &Managed Care

Issues

Cognitive-Behavioral

• Problem-Solving• Self-Monitoring

• Goal Setting•Decision Making Skills

Effective Therapeutic Approaches

Family-Based

Behavioral Approach•Contingency Contracting

•Family Management•Parenting Strategies

•Communication Training

Strategic and Structural•Symptoms of the Family

•Restructuring ProblematicRelationships

Integrative Models•Ecosystem Model

Resources

DiClemente, C.C. (2003). Addiction and change: How addictions develop and addicted people recover. New York: The Guilford Press.

Edgette, J.S. (2006). Adolescent therapy that really works: Helping kids who never asked for help in the first place. New York, NY: W.W. Norton.

Sampl, S & Kadden, R. (2001) Motivational enhancement and behavioral therapy for adolescent cannabis users: 5 sessions. Retrieved June 1, 2007 from http://www.kap.samhsa.gov/products/manuals/cyt/pdfs/cyt1.pdf.

Seita, J.R. & Brendtro, L.K. (2005). Kids who outwit adults.Bloomington, ID: National Education Services.

Straussner, S. L. (Ed.). (2004). Clinical work with substance-abusing clients. 2nd ed. New York: The Guilford Press. Edgette, J.S. (2006). Adolescent therapy that really works: Helping kids who never asked for help in the first place. New York, NY: W.W. Norton.

AdolescentsClinical Practice with Addictive Disorders

Renee Hillsman Tamara Robinson Tracy Tarbutton Tammy Wilbanks

Renee Hillsman Tamara Robinson Tracy Tarbutton Tammy Wilbanks