Youths reluctant treatment partners

6/18/2001

It took a court order to get the seven teens - all with multiple and repeat offenses ranging from shoplifting and drug possession to probation violations - to come to the St. Anthony Villa day-treatment program for chemical dependency.

All have smoked marijuana daily, sometimes skipping school to do it.

They took their first tokes at about age 11 and bonded with their friends - and sometimes their families - through drug use.

But they don't think they have a drug problem.

“My only problem is I got caught,” said one 16-year-old boy. The six other teens nodded in agreement.

Drug counselors face special challenges in helping troubled adolescents.

Most teens in treatment for substance abuse are there only because they were ordered to be there. They have wide differences in their emotional maturity and life experiences, and the consequences of abuse have been different for each and fewer than for adults.

“They're there because they have to be. But hopefully, if you can keep them coming awhile, you can kind of hook them and start working on their issues from their own personal perspective and not just because they're ordered,” said Jay Salvage, executive director of the Lucas County Alcohol and Drug Addiction Services Board.

In Ohio, 11,356 adolescents (age 18 and younger) were treated in publicly funded alcohol and drug addiction programs last year, with about three-fifths of them ordered there by court and law enforcement agencies, according to the Ohio Department of Alcohol and Drug Addiction Services. The rest may be referred by schools, foster care agencies, or their parents.

“Only in rare cases is an adolescent a voluntary client,” said Dr. Nick Piazza, chairman and professor of counseling and mental health services at the University of Toledo. “They're ordered there. They're sent there. They're compelled to be there in some respect.”

In Lucas County last year, 648 juveniles were ordered by juvenile court to some sort of drug and alcohol education or treatment program.

The programs can range in intensity from classes about the effects of drugs and alcohol to outpatient counseling programs to 60-day in-patient programs for chemical dependency treatment and psychological services with regular, long-term follow-up treatment.

Substance-abuse treatment for teens is similar to adults' treatment, with group sessions, 12-step approaches, treatment plans, family therapy, individual counseling, abstinence education, and referrals to self-help groups like Alcoholics Anonymous.

But when the addicts are young and healthy, don't have jobs, don't own homes, and can't easily leave an environment of friends or family who excessively use alcohol and other drugs, they don't have the same life perspective to realize the potential gravity and consequences of drug and alcohol abuse.

“Treatment needs to be specialized for young people,” said Carroll Parks, president and chief executive officer of Substance Abuse Services, Inc., 1832 Adams St. “They're different: how they learn information, how they need more time with their peers.

“We need to have them in treatment programs that are specialized and deal with issues kids are going through at that age: impulsiveness, decision-making, influence from peers. These are things that are appropriate,” he said.

In general, programs for adolescents and adults focus on the chemical dependency as well as family and peer dynamics and issues. But the topics may have varying degrees of importance for each population.

“As far as treatment considerations are concerned, the most important one is getting family involvement. The adolescent has to go back into a family,” Dr. Piazza said.

Adolescent chemical dependency treatment also addresses teen-specific issues and behaviors, like fighting, truancy, curfew violations, and school performance.

Counselors and social workers say they often are challenged to separate serious mental health issues and illnesses from “normal” teenage acting out against parents and teachers.

“Some of it looks, tastes, and smells like adolescence,” said Cathi Coridan, senior director of substance abuse programs and policy at the National Mental Health Association in Alexandria, Va. “When the smoking and drinking begin to interfere with normal activities in a kid's life, then we've got a problem.”

Often teens first are identified as drug and alcohol abusers through poor school performance or criminal behavior. They may have mental health issues like depression, behavioral disorders, or learning disabilities that would improve with assistance beyond the substance-abuse treatment.

“We need to be sure that we're getting to and assessing underlying mental health problems,” Ms. Coridan said.

Most treatment integrates behavioral counseling, chemical dependency treatment, and mental health therapy, though the emphasis of different programs may change depending on a teen's situation.

“They also could have a variety of services like recreational therapy and art therapy to engage kids in the treatment process,” said Dana Harlow, manager of the quality management unit at the Ohio Department of Alcohol and Drug Addiction Services.

Treatment involving family counseling and discussions about how teens can manage their substance abuse in the context of their peer groups is often the most valuable, counselors say.

“One of the first things they talk about in treatment is who influences their drug use and what are the triggers for them to fall back. Usually it's their peer group,” said Alice Anderson, student assistance counselor at Start High School, who oversees support groups for students who want to or have quit using tobacco, alcohol, and other drugs.

And provisions for continuing treatment in outpatient programs, self-help groups, or with mentors also are important for success.

“The students that I've seen who have been successful have been willing to work with either an adult in the counseling office or other adults, someone that keeps checking on them,” Ms. Anderson said.

Still, success is not guaranteed. Tragically, it isn't even very likely.

Teens like those in the St. Anthony Villa day treatment program may well continue using drugs and alcohol. All seven in the recent session said they had smoked marijuana during their first few weeks in the program.

“What happens in reality is that a lot of kids who are placed in treatment go through the motions. They say what you want them to say and do what you want them to do and then go back out and use because it's fun and that's where their friends are,” Judge James Ray of Lucas County Juvenile Court said.

But many eventually respond to the therapies.

A few are immediate success stories, emerging clean and sober. Some need repeated, prolonged, or more intense treatment. Others take longer but retain some of the lessons.

“Do they stop entirely? I don't know,” Judge Ray said. “But at least it's not as much fun as it used to be. That's a step in the right direction.”