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