Substance Abuse Treatment for Adolescents: What to Ask
Substance Abuse Treatment for Adolescents: What to Ask
How hard is it to find a good treatment program for your son or daughter? Here's one example: CEO and Cofounder of Treatment Research Institute (TRI) in Philadelphia, Dr. Thomas McLellan, writes in his Introduction to Anne Fletcher’s Inside Rehab: The Surprising Truth About Addiction Treatment -- and How to Get Help that Works (2013) that, even though he is an expert in the field of addiction, he was unable to get his son into the kind of treatment that could have saved his life.
Thanks to Fletcher’s book and to new evidence-based research being adopted by the best drug and alcohol treatment centers, there is hope for better outcomes today than in the past. Even so, there remains a serious variation in quality of treatment programs, which is why it is best to ask a lot of questions before your son or daughter is admitted to either residential or outpatient rehab.
“When it comes to picking a rehab, most people ask more questions before buying a vacuum,” McLellan (also formerly Deputy Director of the Office of National Drug Control Policy for the Obama Administration) says in Fletcher’s book. In the case of adolescents and young adults (ages 12 to 25), the consumer is really the parent: mom and/or dad are the ones who choose the treatment center and pay for it out of pocket or through their insurance. Answers to key questions may make the difference between wasting money, time, and the best chance for your son or daughter’s recovery.
A superb resource is The Partnership at DrugFree.org, which has been “working toward a vision where all young people will be able to live their lives free of drug or alcohol abuse” since the 1980s. Its website is perhaps the most comprehensive, practical, and accessible resource for parents currently available. Its Treatment e-book is an invaluable introduction to becoming an educated advocate for your child’s recovery. The e-book covers six steps to finding the right help for your child, the last of which is to make calls and ask questions.
Another resource for finding good substance abuse treatment for young people is Principles of Adolescent Substance Use Disorder Treatment: A Research-Based Guide, published by NIDA (National Institute on Drug Abuse, 2014). Coming in the near future will be TRI's "Consumer Guide to Adolescent Substance Abuse Treatment," an evidence-based, comparative guide of quality indicators, using Philadelphia as a prototype for the same guide for different U.S. cities.
The primary parental consideration must be to seek out substance abuse programs specifically geared toward adolescents and young adults. TRI’s Director, Dr. John Cacciola, an expert in the assessment of substance abuse behaviors and co-occurring problems, points out that “the brain is still developing in adolescents and young adults, therefore the way that they process information and the ways that substances can impact the brain are different...Adolescents as a group report abusing different substances than adults, and the symptoms and manifestations of substance abuse disorders are somewhat different.”
Cacciola adds that “adolescents may be even more likely than adults to feel that they do not need treatment, even when they do.” Because of their developmental stage, they may be more rebellious or think of themselves as just doing what all their friends are doing. Moreover, most adolescents enter substance abuse treatment via referral by the criminal justice system or school counselors, hence their motivation (or lack of) for recovery is different from adults who may want to save a marriage or their job, or simply stay alive. No matter how much evidence teens have that drugs and alcohol can ruin their lives, most don’t yet have the stability of a well-lived life, so they don't care as much as an adult does.
Fletcher has 32 bulleted subjects to ask about at the end of her chapter on rehab for teens. Based on Fletcher’s conclusions, feedback from Dr. Cacciola at TRI, information at drugfree.org, and input from other parent consumers of substance use treatment, here are 11 primary questions you must ask before you choose a treatment program for your child along with the follow-up questions for each.
Caveat: If your child is over a certain age (and there are loopholes to age of consent being 18), you won’t have access to their medical records or observations and conclusions by treatment facility personnel unless your child signs a release of information form. If you don’t get that, you will be in a black hole.
1. How does your program for teens and young adults differ from traditional treatment programs for adults? (You should hear the key phrases evidence-based practice and family-based treatment.)
“Evidence-based” means modalities of treatment have been studied and tested and the results were positive. “Family-based” means the parents are engaged in the treatment process. Even ten years ago a Society for the Study of Addiction article noted that research had shown the importance of parent engagement to successful treatment outcomes for young people.
Other considerations for adolescent addiction treatment include these factors unique to young people:
What is the educational component for teens still in school or pursuing their GED?
Are there life skills workshops for dealing with daily life, managing recovery, and getting a job?
What is the communication protocol - how will staff contact me regarding progress and how often can I contact my child?
2. Can your facility diagnose and treat depression, anxiety, and other mental health disorders? Is it a Dual Diagnosis facility?
If your child has already been diagnosed, it is imperative that the program be able to accommodate Dual Diagnosis patients. In Fletcher’s book, Cacciola says “Some studies show that as many as 95 percent of teens with a substance use disorder have some other mental health disorder. Substance abuse is often the overt thing that gets them into treatment, but it’s an underlying problem, such as depression or sexual trauma, that’s really the issue. Substance abuse can be a symptom and is often not the primary problem.”
If it is a dual diagnosis facility, ask these questions:
Who will evaluate my child’s mental health issues?
Will my child be taken off all medications currently prescribed and be re-evaluated or will current meds be maintained until I am notified of indications for change?
How and when will meds be administered and by whom?
Ask whether the treatment facility gives priority to the addiction or to the mental health issue. If they are not treated in tandem progress and recovery are often short-lived.
3. Is your program individualized to fit the needs of my child, or is it a one-size-fits-all program where the individual must adapt to the same expectations for everyone?
For instance, are there choices regarding support groups that include more than just AA or NA 12-Step meetings; are there modifications for those suffering from anxiety or depression who are not yet stabilized on meds?
4. What are the qualifications of the staff and how often and for how long will my child see professional staff while in treatment?
Ascertain who is in charge. Sometimes a doctor’s name is mentioned as being the Medical Director, yet the doctor (a psychiatrist) is rarely onsite and appointments with patients are short or are confined to response to medications.
Who runs group therapy and provides individual therapy? Have they been trained in adolescent development evidence-based modalities of therapy? Who is in charge of crisis situations such as a suicide threat? How much addiction treatment training do the techs who drive the vans have?
While there is a place for peer-supported recovery group therapy and involvement in treatment by other recovering addicts, you want to know that you are getting professional treatment when you are being charged professional rates.
5. What is your philosophy on medication-assisted treatment for opioid addiction?
In 2012, nearly one million Americans, ages 12-25 were abusing or dependent on prescription pain relievers or heroin, according to drugfree.org. If your child is an opioid addict (abusing heroin, Oxycontin, hydrocodone, or other legal or illegal opiates), he or she may already be on an opiate-blocker like buprenorphine (Suboxone) or naltrexone. In the past, heroin addicts were prescribed methadone to keep their addiction under control. Medication-assisted treatment with new drugs is gaining traction because it is highly effective and life-saving, but it is surprisingly controversial. Some facilities consider it is trading one drug for another and do not accept Suboxone or naltrexone as legitimate treatment tools. See drugfree.org’s e-book on medication-assisted treatment for more information, http://medication-assisted-treatment.drugfree.org/ebook.
6. What is the daily and weekly schedule like in regard to group and individual counseling, doctor visits, school, life skills, recreation, and free time?
Look for variety. A major complaint is too much time in group settings and not enough individual counseling. Recreation should include some physical outlets and a chance to experience what it is like to have fun without drugs doing typical teen and young adult activities – not board games or sitting around watching television.
7. What is the typical length of stay at your facility and how is that determined?
Sometimes young people need to stay in residential treatment longer than 28 days simply to stay safe for long enough that they want to live more than they want to risk killing themselves with drugs. The longer they are sober, the better chance they have of staying sober when they leave treatment. Ask about phases of treatment and step-down programs where patients win privileges as their behavior improves. Often this information is not given to the patient upfront or they would never agree to stay and is withheld from a parent because the cost is going to be much more than originally quoted. Ask for numbers on average length of stay.
8. For residential treatment, when and how long is the family education program, what does it consist of, and does the family get to visit or have any counseling outside of that?
Because young people generally go back to the family unit, parents must understand addiction and have insight into how to change negative family dynamics into positive opportunities for communication and support. Some programs only offer addiction education, which serves to scare the heck out of parents and leave them depressed about the reality of the severity of the disease. Ask about Community Reinforcement Approach and Family Training (CRAFT), a great tool for teaching parents how to communicate effectively in order to support their child’s recovery. Download the Center for Motivation and Change’s 20-Minute Guide for Parents from their website to find out more about this.
9. What is the plan for aftercare when treatment is over?
Your child should not leave a treatment facility without an aftercare plan. Attending 12-Step meetings is not a complete plan. Young people have a better chance at staying sober when they are discharged to a transitional step-down setting from residential living. Treatment centers often have ties with sober houses or apartment communities.
In addition, ask if your child will have passes to make visits home to revisit the home setting and family dynamics and then return to the treatment center and process the experience and any challenges in group and individual counseling.
10. How do you or my family handle relapse prevention?
Good programs will work with your child on a relapse prevention program. But what happens if your son or daughter relapses while in treatment? What are the consequences? Will they be kicked out or redirected back into an earlier stage of treatment. What happens if your child relapses at home? Do you send them back to treatment or deal with it in the home setting?
11. How much will it cost?
This is the question we all want to ask first. With substance abuse treatment now covered by most insurance plans, the burden has been lifted, although there are treatment centers that don’t take insurance. Find out upfront what each phase of treatment will cost and discuss your benefits with your insurance company.
Judy Kirkwood is a member of the Parent Support Network, which offers coaching to parents struggling with adolescent addiction issues.