If you are a parent or caregiver searching for answers as to how best to help your child deal with addiction, then you should know that there are no simple answers. Anyone who tells you they have “the answer” is simply not telling the truth.
What makes the problem so challenging for parents, and teens that struggle, is that our adolescent addiction treatment system is badly broken.
Consider the following from a journal article by A. Thomas McLellan and Kathleen Meyers (Biol Psychiatry, 2004, 56:764-770).
A broken adolescent treatment system:
1) There are few programs available, and in some rural areas there are no programs that treat adolescent substance abuse or addiction-related problems. At best, speciality adolescent treatment programs account for less than 15% of all substance abuse treatment currently available in the U.S..
2) About half of all treated adolescents relapse within 6 months of treatment discharge. This outcome reflects the reality that few treatment programs address in any meaningful way the underlying factors motivating addictive behavior.
3) No adolescent addiction treatment provider certification programs exist in the U.S., which means that those who are doing treatment, are not required to pass any kind of proficiency exam. In addition, most state and national credentialing processes do not test incoming counselors on adolescent-specific knowledge.
4) Funding for adolescent addiction treatment is scarce. Many insurance plans do not cover teens, and if they do, coverage is weak. What I find appalling is that many residential programs will prey on parents who are vulnerable and willing to do whatever it takes to help their child, and convince them that paying $1,000 to $1,500 per day for a number of weeks will result in great outcomes – relapse rates far, far less than 50%. Yet the hard data to support these outcomes is practically nonexistent. Even more important, there are far better indicators of treatment success than relapse rates.
In sum, as a parent I would be hard-pressed to send my own child to an adolescent addiction treatment program unless I had thoroughly researched the credentials of the staff, the degree to which the program utilized evidence-based practices, and was convinced there were no better options.
Strategy for treating teen substance abuse
My overall strategy for addressing teen substance abuse and addiction-related problems would be the following:
Do your homework:
There is no substitute for spending time gaining knowledge of addiction, treatment, and the specific issues that are applicable to teens. Read the information on this website, on other websites, and talk to experts from various disciplines including: researchers, clinicians, experts in adolescent development, education, etc..
It is important that you sythesize the information for yourself, make up your own mind about who to believe, what to believe, and the right course of action for your child since you know them better than anyone!
Learn about CRAFT:
CRAFT stands for the community reinforcement and family training program that is among the best evidence-based interventions we have for helping you deal with your child’s addiction and engaging your child in treatment. I urge you to read more about CRAFT and begin implementing the program as soon as you can!
Learn about evidence-based practices for adolescents:
Multi-dimensional family therapy (MDFT) developed by Howard Liddle and his colleagues at CTRADA, treats the adolescent in the context of his/her family, friends and peers. Multisystemic therapy (MST), developed by Scott Henggeler, is a similar social-ecological approach with an equally impressive track record.
Brief Strategic Family Therapy provides yet another evidence-based approach that also takes a systems approach to intervention and involves family members. Your goal is not to become an expert in these therapies, but to acquaint yourself with them enough to be able to make informed choices about treatments you may select for your child. Ideally, the providers or programs you choose use one of these approaches.
Utilize outpatient private practice clinicians:
Seek out clinicians in private practice that have the academic knowledge, clinical skills, and licenses/credentials to successfully treat your child. In practically all cases, it is possible to utilize intensive outpatient therapy in place of expensive residential treatment to achieve positive long-term outcomes.
Even in communities where there are no adolescent addiction treatment programs, there are usually experienced clinicians in private practice who can help.
- Licensed clinical social workers
- Psychiatric mental health nurse practitioners
Refer to my article: How to find a good therapist for additional information.
Realize that what you are going through is traumatic:
Focusing considerable time and energy on helping your child often has the unintended consequence of ignoring your own mental health. Both Beautiful Boy: A Father’s Journey Through His Son’s Addiction and Cost: A Novel provide heart wrenching accounts of the toll adolescent addiction takes on families.
Whether you realize it or not, you may be suffering from a form of traumatic stress and benefit from trauma treatment. The essence of trauma is responding to overwhelming emotional stressors by either fighting, fleeing, or freezing. Interestingly, these responses very often parallel how parents interact and respond to their child’s behaviors.
These responses also lead to a wide variety of symptoms that often get misinterpreted as other mental or physical health problems. Checkout perhaps the best trauma resource online, trauma pages, and the book 8 Keys to Safe Trauma Recovery.
You will not be much help to your child if your actions are motivated unknowingly by unresolved trauma.
Understand the role of risk and protective factors in altering the course of your child’s behaviors:
A tremendous amount of research indicates that a host of risk and protective factors help explain why particular kids go down a path of engaging in objects of addiction, while others are immune to abuse/addiction problems.
As a parent, the key is to do your own assessment of the risk and protective factors existing in your family, extended family, child’s peer groups, schools, community, and the county in which you live. A good source for exploring how your county stacks up to other counties on a variety of risk and protective factors can be found on the CHSI website.
Another book that provides a concise overview of what every child needs to make it in the world is The Irreducible Needs Of Children. Such a profile can provide a powerful picture of potential leverage points for altering the future trajectory of behaviors of your child.
The idea is to identify the most salient risk factors and begin to explore how you can decrease or remove them from your child’s life.
For example, this may mean:
- Taking a hard look at unhealthy behavior patterns in your own marriage/family and engaging in family therapy.
- Working with your child’s teachers to identify barriers to academic commitment and/or other issues like bullying, lack of friends, etc.
- Moving to a new community where your child is surrounded by more protective factors and less risk factors.
At the same time, your efforts should also focus on enhancing protective factors that may be missing from your child’s life. One component of this work is exploring what things engages your child most in life: music, art, science, writing, outdoors, etc..
Although it is true drug abuse can make it seem like your child has no other interest than drugs, for every child there was a life before drugs and addiction. Every child (and adult) has natural talents and innate interests that we must identify and nurture.
Understand how to track, measure and celebrate your child’s success:
In your search for answers as to how best to help your child, you likely will come to believe that abstinence is the gold standard for
assessing whether interventions have been successful. To some degree, this makes sense. If my kid is not abusing then all will be alright.
Unfortunately, this is seldom true because most often the underlying factors that initiated and perpetuate addictive behavior are rarely addressed in treatment. You may see a positive short-term outcome, but then become depressed when your child relapses months or years later.
What is the best measure of progress? This takes us back to the idea that addictions are ultimately about relationships. For most teens who struggle with abuse or addiction, emotional development becomes side-tracked in ways that makes it very difficult for them to initiate, engage, and maintain healthy intimate relationships.
In most cases, they gravitate towards other kids who have the same developmental deficits and constrictions (or lack of relationship skills). What bonds these kids over time are the objects of addiction they share: alcohol, cigarettes, pot, hard drugs, etc…
The longer they engage in abuse and addiction behavior, the more they cheat themselves of the developmental skills they need to make it in the world.
This brings us back to what our measure of success should be from intervention: how well your child advances within and through the emotional stages of development, with the goal of developing the capacities necessary to engage and succeed in life.
Abstinence is important and a necessary precursor to what you want for your child, but it falls significantly short of what has to happen for your child to succeed long-term in life. A good overview of this topic is found in the book The Growth of the Mind by Stanley Greenspan, particularly chapter 8 (mental health: a developmental view) and chapter 9 (pep pills, pep talks, and real therapeutic experiences).
Invest in the HBO series Addiction:
Amazon sells the Addiction DVDs for about $30, and it is among the best resources I have found for parents (and struggling teens) on many topics related to understanding and treating addiction.
I mentioned above that one of the segments focuses on CRAFT, but there are nine primary segments and an additional 13 supplemental segments covering important topics such as: relapse, the adolescent addict, interviews with experts, drug courts, medications, and how to select good treatment programs.
What I like best about this series is that the speakers are all trusted leaders in the addiction field.